Human neuregulin-1 (nrg-1) recombinant fusion protein compositions and methods of use thereof

ABSTRACT

The present invention relates to a recombinant fusion protein comprising a fragment of the cardioprotective protein neuregulin-1 (NRG-1) fused to a monoclonal antibody (mAb) backbone and to a method of treating a disease or condition in a subject in need thereof comprising administering a therapeutically effective amount of the recombinant fusion protein or the pharmaceutical composition comprising the recombinant fusion protein disclosed herein.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority to, and the benefit of, U.S.Provisional Application No. 62/656,246, filed on Apr. 11, 2018, thecontents of which are incorporated herein by reference in theirentirety.

INCORPORATION BY REFERENCE OF SEQUENCE LISTING

The instant application contains a Sequence Listing which has beensubmitted in ASCII format via EFS-Web and is hereby incorporated byreference in its entirety. Said ASCII copy, created on Mar. 16, 2019, isnamed SBTI-001-001US_SeqList.txt and is 31,328 bytes in size.

BACKGROUND OF THE INVENTION

Neuregulin (NRG; heregulin, HRG), also known as glial growth factor(GGF) and new differentiation factor (NDF), is a type of glycoproteinwith a molecular weight of 44 KD. The NRG protein family has fourmembers: NRG-1, NRG-2, NRG-3 and NRG-4. NRG (including NRG-1) plays aparticularly important role in the development of the heart. As a ligandof tyrosine kinase receptors of the ErbB family, NRG-1 directly binds tomembrane-bound ErbB3 or ErbB4, inducing dimerization to createErbB2/ErbB4, ErbB2/ErbB3, ErbB3/ErbB3 and ErbB4/ErbB4 complexes, andsubsequent intracellular signaling. In animal models, expression of NRGinduces paracrine signaling to promote growth and differentiation incardiac tissue during embryogenesis, with deletion of any of ErbB2,ErbB4 or NRG-1 leading to embryonic lethality. Further, cancer therapiesblocking ErbB2 receptor signaling have been shown to have significantcardiotoxicity side-effects, demonstrating in humans that ErbB2-mediatedsignaling is essential not only for development but also for thehomeostasis of healthy cardiac tissue.

Evidence also shows that NRG-1 signal transduction plays a part in thedevelopment and function of other organ systems, as well as in thepathogenesis of human disease (including schizophrenia and head and neckcancer). NRG-1 has many isomers. Research in gene mutated mice (geneknock-out mice) indicates that isomers with different N terminal regionsor EGF-like domains have different in vivo functions. The presentinvention is based on the NRG-1βa2 isoform.

Endogenous NRG-1 binds to and induces signaling through both ErbB3(HER3) and ErbB4 (HER4). Numerous pre-clinical and clinical studies haveshown the therapeutic potential of NRG-1 across a variety ofcardiovascular indications, principally through its interactions withcardiomyocyte-expressed ErbB4 (HER4). However, three key factors limitthe clinical applications and utility of recombinant human NRG-1(rhNRG-1). First, signaling of NRG-1 through HER3 may promote cancerdevelopment and/or progression, raising significant concerns for anyapplication requiring chronic administration or without gravecardiovascular (CV) risk factors. Second, over-activation of HER3 byNRG-1 may disrupt gastrointestinal (GI) epithelial integrity andhomeostasis, leading to severe GI toxicity and thus loss of therapeuticwindow for NRG-1. Third, both clinical-stage active protein fragments ofrhNRG-1 have shown a short half-life, indicating that burdensome dosingand administration schedules may be required to achieve the desiredtherapeutic levels of exposure. Hence, there exists a need to provide anNRG-1-based therapeutic which retains clinically significant therapeuticpotential across a variety of cardiovascular indications, but with lowerrisk of oncogenesis or promotion of cancer progression, better GItolerability, and a more favorable pharmacokinetic (PK) profile.

The present invention addresses these needs by providing a recombinantprotein comprising a fusion of the rhNRG-1 active domain with aHER3-specific antagonist antibody: HER3 signaling is blocked in a waythat mitigates the oncogenic risk and GI toxicity of rhNRG-1, and at thesame time the antibody backbone format confers a molecular half-life ofa typical monoclonal antibody, enabling more convenient dosing andadministration for the product.

SUMMARY OF THE INVENTION

In one aspect, the present invention relates to a recombinant fusionprotein comprising a fragment of the cardioprotective proteinneuregulin-1 (NRG-1) fused to a monoclonal antibody (mAb) backbone. In arelated aspect, the NRG-1 fragment is fused to the C-terminus of theantibody heavy chain via a linker. In another related aspect, NRG-1 isattached to the linker via the first (1^(st)) amino acid on theN-terminus of NRG-1, which in one embodiment is a Serine (S or Ser)amino acid. In a related aspect, the fragment is an active fragment thatcomprises the active domain of NRG-1. In another related aspect the mAbis monospecific for ErbB3 (HER3). In another related aspect, the NRG-1is the NRG-1 β2a isoform.

In another aspect, the invention relates to a pharmaceutical compositioncomprising a recombinant fusion protein comprising a fragment of thecardioprotective protein neuregulin-1 (NRG-1) fused to an anti-HER3monoclonal antibody backbone and a pharmaceutically acceptable carrier,diluent or excipient.

In another aspect, the invention relates to a method of treating adisease or condition in a subject in need thereof, the method comprisingadministering a therapeutically effective amount of the recombinantfusion protein or the pharmaceutical composition comprising therecombinant fusion protein disclosed herein.

In another aspect, the invention relates to a method of preventing,inhibiting, suppressing or delaying the onset of a cardiovasculardisease or condition in a subject, the method comprising administeringan effective amount of the recombinant fusion protein disclosed herein.

In another aspect, the invention relates to a method of treating aCNS-related disease or condition in a subject in need thereof, themethod comprising administering a therapeutically effective amount ofthe recombinant fusion protein.

In another aspect, the invention relates to a method of preventing,inhibiting, suppressing or delaying the onset of a CNS-related diseaseor condition in a subject, the method comprising administering aneffective amount of the recombinant fusion protein.

In another related aspect, the NRG-1 binds to and induces signalingthrough ErbB4 (HER4). In another related aspect, the mAb inhibits NRG-1signaling through ErbB3 (HER3).

In another aspect, the invention relates to a kit comprising aneffective amount of a recombinant fusion protein of the invention orpharmaceutical composition comprising a recombinant fusion protein ofthe invention.

Other features and advantages of the present invention will becomeapparent from the following detailed description examples and figures.It should be understood, however, that the detailed description and thespecific examples while indicating embodiments of the invention aregiven by way of illustration only, since various changes andmodifications within the spirit and scope of the invention will becomeapparent to those skilled in the art from this detailed description.

BRIEF DESCRIPTION OF THE DRAWINGS

Various objects and advantages and a more complete understanding of thepresent invention are apparent and more readily appreciated by referenceto the following Detailed Description and to the appended claims whentaken in conjunction with the accompanying Drawing wherein:

FIG. 1 shows the Construction of the expression plasmids for expressingthe recombinant fusion protein disclosed herein.

FIGS. 2A-2D illustrate the schematic structure of the recombinant fusionprotein disclosed herein. FIG. 2A illustrates a molecular schematic ofan anti-HER3 mAb/NRG-1 fusion protein of the disclosure. FIG. 2B showsrepresentative data generated by SDS-PAGE analysis. FIG. 2C showsWestern blot results detected by primary antibody specific for the61-amino acid active fragment of NRG-1 comprising the HER3/4 bindingdomain (“NRG-1”, R&D Systems, Minneapolis, Minn.). FIG. 2D shows Westernblot results detected by primary antibody specific for IgG.

FIG. 3 illustrates a binding analysis showing that the recombinantfusion protein disclosed herein binds to HER3 protein (Curve 1, Step 2)and can simultaneously bind an anti-NRG-1 antibody (Curve 1, Step 3).Note that Fc mutations were introduced into the recombinant fusionprotein disclosed herein to knock out the Fc effector function of theparent antibody sequence encoding a HER3 specific antibody, which maymitigate the undesired cytotoxicity towards normal tissues expressingHER3 receptor.

FIGS. 4A-4D show representative graphs showing the mean relative growthrate±SEM (n=3) for different cancer cell lines treated with an anti-HER3mAb/NRG-1 fusion protein or controls. FIG. 4A shows the mean relativegrowth rate in the NCI-N87 gastric cancer cell line. FIG. 4B shows themean relative growth rate in the MCF-7 breast cancer cell line. FIG. 4Cshows the mean relative growth rate in the RT-112 bladder cancer cellline. FIG. 4D shows the mean relative growth rate in the T47D breastcancer cell line. Compared to the control NRG-1 peptide and GP120mAb/NRG-1 fusion protein, the recombinant fusion protein provided hereindemonstrates markedly lower activity in promoting cancer cellproliferation.

FIGS. 5A-5B illustrate that despite reduced cancer cell growthpotential, the recombinant fusion protein provided herein fullypreserves the ability to induce PI3K/AKT signaling incardiomyocytes—demonstrating comparable activity to recombinant NRG-1and GP120 mAb/NRG-1 fusion protein. FIG. 5A is a plot showing therelative ratio of phospho-AKT (pAKT) to total AKT (tAKT) versus antibodyconcentration (in nM) in human cardiomyocytes treated with therecombinant fusion protein of the disclosure and controls. FIG. 5B is aWestern Blot analysis of AKT phosphorylation in human cardiomyocytestreated with the recombinant fusion protein of the disclosure andcontrols.

FIGS. 6A-6C show direct comparison of HER2/4 and HER2/3 dimerization inthe presence of the recombinant fusion protein disclosed herein andcontrols. FIG. 6A shows the assay principle for detecting ligand-induceddimerization. PathHunter Dimerization Assay developed by EurofinsDiscoverX (Fremont, Calif.) is used for detecting ligand-induceddimerization of two subunits of a receptor-dimer pair. β-gal enzyme issplit into two fragments, ProLink (PK) and enzyme receptor (EA). Thecells have been engineered to co-express target protein 1 fused toenzyme donor PK, and target protein 2 fused to enzyme acceptor EA.Binding of ligand to one target protein induces it to interact with theother target protein, forcing complementation of the two enzymefragments and resulting in the enzyme reaction to releasechemiluminescent signal which is detected as Relative Fluorescence Unitor RFU. FIG. 6B is a plot illustrating that the recombinant fusionprotein provided herein can induce HER2/HER4 dimerization with potencycomparable to NRG-1. FIG. 6C is a plot illustrating that the recombinantfusion protein provided herein is significantly less potent than NRG-1in inducing HER2/HER3 dimerization. These findings further validate thatthe recombinant fusion protein provided herein preserves the full HER2/4signaling potential of NRG-1 while significantly reducing HER2/3signaling induction.

FIG. 7 illustrates the binding affinity of anti-HER3 mAb/NRG-1 fusionprotein of the invention to HER3 antigen across different speciesincluding human, monkey, rat and mouse. The equilibrium dissociationrate (KD) determined by BIAcore analysis is 3.13×10⁻¹⁰ (human),3.97×10⁻¹⁰ (monkey), 2.68×10⁻⁹ (rat) and 2.77×10⁻⁹ (mouse),respectively. These data indicate that the recombinant fusion protein ofthe invention has a similar binding affinity to human and monkey HER3,whereas its affinity to rodent (rat and mouse) HER3 is lower byapproximately one order of magnitude.

FIG. 8 is a plot that illustrates the effect of the recombinant fusionprotein on ejection fraction (EF) in rat model of systolic heart failureinduced by coronary artery ligation.

FIG. 9 is a series of 6 images that show histopathological changes incardiac muscle structure in a rat model of systolic heart failureinduced by coronary artery ligation. Cardiac tissues next to thesurgical site were collected and fixed in 4% formaldehyde, paraffinsections were then prepared and stained with H&E. The top left imageshows cardiac tissue from a sham surgery control rat. The top middleimage shows cardiac tissue from a systolic heart failure model rattreated with vehicle control. The top right image shows cardiac tissuefrom a systolic heart failure model rat treated with GP120 mAb/NRG-1 (10mg/kg). The bottom left image shows cardiac tissue from a systolic heartfailure model rat treated with anti-HER3 mAb/NRG-1 (1 mg/kg). The bottommiddle image shows cardiac tissue from a systolic heart failure modelrat treated with anti-HER3 mAb/NRG-1 (3 mg/kg). The bottom right imageshows cardiac tissue from a systolic heart failure model rat treatedwith anti-HER3 mAb/NRG-1 (10 mg/kg).

FIG. 10 is a graph illustrating the evaluation of in vivo anti-tumoractivity using a subcutaneous FaDu carcinoma xenograft model in NOD/SCIDmice.

FIG. 11 is a graph illustrating body-weight changes in tumor bearingmice treated with the recombinant fusion protein of the disclosure andcontrols.

FIG. 12 is a graph illustrating the pharmacokinetic profile of therecombinant fusion protein in cynomolgus monkeys (macaques).

DETAILED DESCRIPTION

The current invention utilizes a recombinant fusion protein comprising afusion between a monoclonal antibody-fused to an active fragment of aneuregulin-1 protein isoform across a variety of cardiovascular andcentral nervous system (CNS) indications.

Definitions

Unless defined otherwise, technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs.

For purposes of interpreting this specification, the followingdefinitions will apply and whenever appropriate, terms used in thesingular will also include the plural and vice versa. In the event thatany definition set forth below conflicts with any document incorporatedherein by reference, the definition set forth below shall control.

“Neuregulin or neuregulin analogs” are molecules that can activateErbB2/ErbB4 or ErbB2/ErbB3 heterodimer protein tyrosine kinases, such asall neuregulin isoforms, neuregulin EGF domain alone, neuregulinmutants, and any kind of neuregulin-like gene products that alsoactivate the above receptors. The preferred “neuregulin” used in thisinvention is a polypeptide fragment of human neuregulin 1 β2 isoformcontaining the EGF-like domain and the receptor binding domain. In oneembodiment, the neuregulin fragment is an active fragment. Neuregulin-1(NRG-1) and isoforms thereof are also known in the art as neuregulin 1(NRG1), glial growth factor (GGF), Heregulin (HGL), HRG, newdifferentiation factor (NDF), ARIA, GGF2, HRG1, HRGA, SMDF, MST131,MSTP131 and NRG1 intronic transcript 2 (NRG1-IT2).

The terms “ErbB3”, “ErbB3 (HER3)”, “HER3” refer to the same protein (orthe same gene when in reference thereto) and are used interchangeablyherein. In some embodiments, the recombinant fusion comprises amonoclonal antibody portion that is specific for ErbB3. ErbB3 (erb-b2receptor tyrosine kinase 3) is also known in the art as FERLK, LCCS2,ErbB-3, c-erbB3, erbB3-S, MDA-BF-1, c-erbB-3, p180-ErbB3, p45-sErbB3 andp85-sErbB3.

In one embodiment, the terms “ErbB4”, “ErbB4 (HER4)”, “HER4” refer tothe same protein (or the same gene when in reference thereto) and areused interchangeably herein. ErbB4 (erb-b2 receptor tyrosine kinase 4)is also known in the art as ALS19 and p180erbB4.

In one embodiment, the terms “ErbB2”, “ErbB2 (HER2)”, “HER2” refer tothe same protein (or the same gene when in reference thereto) and areused interchangeably herein. ErbB2 (erb-b2 receptor tyrosine kinase 2)is also known in the art as NEU, NGL, TKR1, CD340, HER-2, MLN 19 andHER-2/neu.

The term “active,” as used herein, refers to a fragment having abiological activity or biological function. In some embodiments, theactivity is equal to or approximates the activity of the wild-typeprotein.

The term “subject” as used herein includes, but is not limited to, amammal, including, e.g., a human, non-human primate (e.g., monkey),mouse, pig, cow, goat, rabbit, rat, guinea pig, hamster, horse, monkey,sheep, or other non-human mammal, a non-mammal, including, e.g., anon-mammalian vertebrate, such as a bird (e.g., a chicken or duck) or afish; and a non-mammalian invertebrate. In some embodiments, the methodsand compositions of the invention are used to treat (bothprophylactically and/or therapeutically) non-human animals. The term“subject” can also refer to patients, i.e. individuals awaiting orreceiving medical care.

The term “pharmaceutical composition” herein means a compositionsuitable for pharmaceutical use in a subject, including an animal orhuman. A pharmaceutical composition generally comprises an effectiveamount of an active agent (e.g., the recombinant fusion proteins of theinvention) and a pharmaceutically acceptable carrier, diluent orexcipient (e.g., a buffer, adjuvant, or the like).

The term “effective amount” means a dosage or amount sufficient toproduce a desired result. The desired result may comprise an objectiveor subjective improvement in the recipient of the dosage or amount(e.g., long-term survival, decrease in number and/or size of tumors,effective prevention of a disease state, etc.).

A “prophylactic treatment” is a treatment administered to a subject whodoes not display signs or symptoms of a disease, pathology, or medicaldisorder, or displays only early signs or symptoms of a disease,pathology, or disorder, such that treatment is administered for thepurpose of diminishing, preventing, or decreasing the risk of developingthe disease, pathology, or medical disorder. A prophylactic treatmentfunctions as a preventative treatment against a disease or disorder. A“prophylactic activity” is an activity of an agent, such as therecombinant fusion protein of the invention, or composition thereof,that, when administered to a subject who does not display signs orsymptoms of a pathology, disease or disorder (or who displays only earlysigns or symptoms of a pathology, disease, or disorder) diminishes,prevents, or decreases the risk of the subject developing the pathology,disease, or disorder. A “prophylactically useful” agent or compound(e.g., a recombinant fusion protein of the invention) refers to an agentor compound that is useful in diminishing, preventing, treating, ordecreasing development of a pathology, disease or disorder.

A “therapeutic treatment” is a treatment administered to a subject whodisplays symptoms or signs of pathology, disease, or disorder, in whichtreatment is administered to the subject for the purpose of diminishingor eliminating those signs or symptoms of pathology, disease, ordisorder. A “therapeutic activity” is an activity of an agent, such arecombinant fusion protein of the invention, or a composition thereof,that eliminates or diminishes signs or symptoms of a pathology, diseaseor disorder, when administered to a subject suffering from such signs orsymptoms. A “therapeutically useful” agent or compound (e.g., arecombinant fusion protein of the invention) indicates that an agent orcompound is useful in diminishing, treating, or eliminating such signsor symptoms of the pathology, disease or disorder.

The term “treating cancer” as used herein, unless otherwise indicated,means reversing, alleviating, inhibiting the progress of, or preventing,either partially or completely, the growth of tumors, tumor metastases,or other cancer-causing or neoplastic cells in a subject. The term“treatment” as used herein, unless otherwise indicated, refers to theact of treating.

The term “treating cardiovascular disease” as used herein, unlessotherwise indicated, means preventing, inhibiting, suppressing,delaying, reversing, or alleviating, either partially or completely, theonset of a cardiovascular disease or condition in a subject, or theprogression of a pre-existing cardiovascular disease or condition, or asymptom thereof, in a subject. Non-limiting examples of cardiovasculardiseases that can be treated by the methods of the disclosure includechronic heart failure/Congestive heart failure (CHF), acute heartfailure/myocardial infarction (MI), left ventricular systolicdysfunction, reperfusion injury associated with MI, chemotherapy-inducedcardiotoxicity (adult or pediatric), radiation-induced cardiotoxicity,adjunct to surgical intervention in pediatric congenital heart disease.Non-limiting examples of symptoms of cardiovascular disease includeshortness of breath, cough, rapid weight gain, swelling in legs, anklesand abdomen, dizziness, fatigue, weakness, dizziness, chest pain,fainting (syncope), tachychardia and bradychardia. Methods ofdetermining the progression of cardiovascular disease and theeffectiveness of treatment will be readily apparent to one of ordinaryskill in the art. For example, the progression of various cardiovasculardiseases can be determined by ejection fraction, electrocardiogram(ECG), Holter monitoring, echocardiogram, stress test, cardiaccatheterization, cardiac computerized tomography (CT) scan and cardiacmagnetic resonance imaging (MRI).

The term “treating a central nervous system (CNS)-related disease” asused herein, unless otherwise indicated, means method of preventing,inhibiting, suppressing, delaying, reversing or alleviating, eitherpartially or completely, the onset of a CNS-related disease or conditionin a subject. The term “treating a CNS-related disease” also can alsomean reversing, slowing or otherwise alleviating a pre-existingCNS-related disease or condition, or a symptom thereof. Exemplary butnon-limiting examples of CNS-related disease or conditions that can betreated with the methods of the disclosure include amyotrophic lateralsclerosis (ALS), Parkinson's disease, Alzheimer's Disease, Bell's Palsy,epilepsy and seizures, Guillain-Barre Syndrome, stroke, traumatic braininjury, multiple sclerosis or a combination. Treating CNS-relateddiseases can improve or prevent symptoms such as tremors, bradykinesia,rigid muscles, loss of balance, impaired posture, speech changes, lossof motor control, paralysis, trouble swallowing, muscle cramps,seizures, memory loss and confusion.

The terms “identical” or “percent identity,” in the context of two ormore nucleic acids or polypeptide sequences, refer to two or moresequences or subsequences that are the same or have a specifiedpercentage of nucleotides or amino acid residues that are the same, whencompared and aligned for maximum correspondence. To determine thepercent identity, the sequences are aligned for optimal comparisonpurposes (e.g., gaps can be introduced in the sequence of a first aminoacid or nucleic acid sequence for optimal alignment with a second aminoor nucleic acid sequence). The amino acid residues or nucleotides atcorresponding amino acid positions or nucleotide positions are thencompared. When a position in the first sequence is occupied by the sameamino acid residue or nucleotide as the corresponding position in thesecond sequence, then the molecules are identical at that position. Thepercent identity between the two sequences is a function of the numberof identical positions shared by the sequences (i.e., % identity=# ofidentical positions/total # of positions (e.g., overlappingpositions)×100). In some embodiments, the two sequences are the samelength.

The term “substantially identical,” in the context of two nucleic acidsor polypeptides, refers to two or more sequences or subsequences thathave at least 90%, at least 91%, at least 92%, at least 93%, at least94%, at least 95%, at least 96%, at least 97%, at least 98% identity, orat least 99% identity (e.g., as determined using one of the methods setforth infra).

As used herein, the term “binds,” “specifically binds to,” or is“specific for” refers to measurable and reproducible interactions suchas binding between a target and an antibody, which is determinative ofthe presence of the target in the presence of a heterogeneous populationof molecules including biological molecules. For example, an antibodythat specifically binds to a target (which can be an epitope) is anantibody that binds this target with greater affinity, avidity, morereadily, and/or with greater duration than it binds to other targets. Inone embodiment, the extent of binding of an antibody to an unrelatedtarget is less than about 10% of the binding of the antibody to thetarget as measured, for example, by a radioimmunoassay (RIA). In certainembodiments, an antibody that specifically binds to a target has adissociation constant (Kd) of <1 μM, <100 nM, <10 nM, <1 nM, or <0.1 nM.

In certain embodiments, an antibody specifically binds to an epitope ona protein that is conserved among the protein from different species. Inanother embodiment, specific binding can include, but does not requireexclusive binding.

As used in this specification, the singular forms “a”, “an”, and “the”include plural references unless the context clearly dictates otherwise.Thus, for example, references to “neuregulin” or “a neuregulin peptide”includes mixtures of such neuregulins, neuregulin isoforms, and/orneuregulin-like polypeptides. Reference to “the formulation” or “themethod” includes one or more formulations, methods, and/or steps of thetype described herein and/or which will become apparent to those personsskilled in the art upon reading this disclosure.

The term “polypeptide” refers to a polymer of amino acids and itsequivalent and does not refer to a specific length of a product; thus,“peptides” and “proteins” are included within the definition of apolypeptide. Also included within the definition of polypeptides are“antibodies” as defined herein. A “polypeptide region” refers to asegment of a polypeptide, which segment may contain, for example, one ormore domains or motifs (e.g., a polypeptide region of an antibody cancontain, for example, one or more complementarity determining regions(CDRs)). The term “fragment” refers to a portion of a polypeptidepreferably having at least 20 contiguous or at least 50 contiguous aminoacids of the polypeptide.

Unless otherwise indicated by context, a “derivative” is a polypeptideor fragment thereof having one or more non-conservative or conservativeamino acid substitutions relative to a second polypeptide (also referredto as a “variant”); or a polypeptide or fragment thereof that ismodified by covalent attachment of a second molecule such as, e.g., byattachment of a heterologous polypeptide, or by glycosylation,acetylation, phosphorylation, and the like. Further included within thedefinition of “derivative” are, for example, polypeptides containing oneor more analogs of an amino acid (e.g., unnatural amino acids and thelike), polypeptides with unsubstituted linkages, as well as othermodifications known in the art, both naturally and non-naturallyoccurring.

An “isolated” polypeptide is one which has been identified and separatedand/or recovered from a component of its natural environment.Contaminant components of its natural environment are materials whichwould interfere with diagnostic or therapeutic uses for the polypeptide,and may include enzymes, hormones, and other proteinaceous ornonproteinaceous solutes. An isolated polypeptide includes an isolatedantibody, or a fragment or derivative thereof.

The term “about” as used herein means in quantitative terms plus orminus 5%, or in another embodiment plus or minus 10%, or in anotherembodiment plus or minus 15%, or in another embodiment plus or minus20%.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which the invention belongs. Although any methods andmaterials similar or equivalent to those described herein can be used inthe practice or testing of the present invention, the preferred methodsand materials are now described. All publications mentioned herein areincorporated herein by reference for the purpose of disclosing anddescribing material for which the reference was cited in connectionwith.

Recombinant Fusion Protein—Antibody

The current invention utilizes a recombinant fusion protein comprising afusion between a monoclonal antibody-fused to a fragment of aneuregulin-1 protein isoform for use across a variety of cardiovascularand neurologic indications. In typical embodiments, the antibody isspecific for ERBB3 (HER3).

As used herein, an “antibody” refers to a protein comprising one or morepolypeptides substantially or partially encoded by immunoglobulin genesor fragments of immunoglobulin genes. The recognized immunoglobulingenes include the kappa, lambda, alpha, gamma, delta, epsilon and muconstant region genes, as well as myriad immunoglobulin variable regiongenes. Light chains are classified as either kappa or lambda. Heavychains are classified as gamma, mu, alpha, delta, or epsilon, which inturn define the immunoglobulin classes, IgG, IgM, IgA, IgD and IgE,respectively. A typical immunoglobulin (e.g., antibody) structural unitcomprises a tetramer. Each tetramer is composed of two identical pairsof polypeptide chains, each pair having one “light” (about 25 kD) andone “heavy” chain (about 50-70 kD). The N-terminus of each chain definesa variable region of about 100 to 110 or more amino acids primarilyresponsible for antigen recognition. The terms variable light chain (VL)and variable heavy chain (VH) refer to these light and heavy chains,respectively.

Antibodies exist as intact immunoglobulins or as a number of wellcharacterized fragments produced by digestion with various peptidases.Thus, for example, pepsin digests an antibody below the disulfidelinkages in the hinge region to produce F(ab′)2, a dimer of Fab whichitself is a light chain joined to VH-CH1 by a disulfide bond. TheF(ab′)2 may be reduced under mild conditions to break the disulfidelinkage in the hinge region thereby converting the F(ab′)2dimer into anFab′ monomer. The Fab′ monomer is essentially an Fab with part of thehinge region (see, Fundamental Immunology, W. E. Paul, ed., Raven Press,New York (1999), for a more detailed description of other antibodyfragments). While various antibody fragments are defined in terms of thedigestion of an intact antibody, one of skill will appreciate that suchFab′ fragments, etc. may be synthesized de novo either chemically or byutilizing recombinant DNA methodology. Thus, the term antibody, as usedherein also includes antibody fragments either produced by themodification of whole antibodies or synthesized de novo usingrecombinant DNA methodologies. Antibodies include single chainantibodies, including single chain Fv (sFv or scFv) antibodies in whicha variable heavy and a variable light chain are joined together(directly or through a peptide linker) to form a continuous polypeptide.Antibodies include single domain antibodies, which comprise an antibodyfragment consisting of a single monomeric variable antibody domain thatis able to bind selectively to an antigen domain. Exemplary singledomain antibodies include VHH fragments, which were originally isolatedfrom camelids.

The antibody domain of the fusion protein optionally comprises all orpart of an immunoglobin molecule and optionally contains all or part ofan immunoglobin variable region (i.e., the area of specificity for thedisease related antigen) and optionally comprises region(s) encoded by aV gene, and/or a D gene and/or a J gene.

As explained above (see, Definitions, supra) the antibodies used hereinoptionally comprise F(ab)2, F(ab′)2, Fab, Fab′, scFv, single domainantibodies, etc. depending upon the specific requirements of theembodiment. Some embodiments utilize fusion proteins comprising IgGdomains. However, other embodiments comprise alternate immunoglobinssuch as IgM, IgA, IgD, and IgE. Furthermore, all possible isotypes ofthe various immunoglobins are also encompassed within the currentembodiments. Thus, IgG1, IgG2, IgG3, etc. are all possible molecules inthe antibody domains of the antibody-immunostimulant fusion proteinsused in the invention. In addition to choice in selection of the type ofimmunoglobin and isotype, different embodiments of the inventioncomprise various hinge regions (or functional equivalents thereof). Suchhinge regions provide flexibility between the different domains of theantibody-immunostimulant fusion proteins. See, e.g., Penichet, et al.2001 “Antibody-cytokine fusion proteins for the therapy of cancer” JImmunol Methods 248:91-101.

In some embodiments, the mAb comprised by the recombinant fusion proteinof the invention is monospecific for ErbB3 (HER3)).

Human HER3 (ErbB-3, ERBB3, c-erbB-3, c-erbB3, receptor tyrosine-proteinkinase erbB-3) encodes a member of the epidermal growth factor receptor(EGFR) family of receptor tyrosine kinases which also includes HER1(also known as EGFR), HER2, and HER4 (Kraus, M. H. et al, PNAS 86 (1989)9193-9197; Plowman, G. D. et al, PNAS 87 (1990) 4905-4909; Kraus, M. H.et al, PNAS 90 (1993) 2900-2904). Like the prototypical epidermal growthfactor receptor, the transmembrane receptor HER3 consists of anextracellular ligand-binding domain (ECD), a dimerization domain withinthe ECD, a transmembrane domain, an intracellular protein tyrosinekinase domain (TKD) and a C-terminal phosphorylation domain. Thismembrane-bound HER3 protein has a Heregulin (HRG) binding domain withinthe extracellular domain but not an active kinase domain. It thereforecan bind this ligand but not convey the signal into the cell throughprotein phosphorylation. However, it does form heterodimers with otherHER family members which do have kinase activity. Heterodimerizationleads to the activation of the receptor-mediated signaling pathway andtransphosphorylation of its intracellular domain. Dimer formationbetween HER family members expands the signaling potential of HER3 andis a means not only for signal diversification but also signalamplification. For example the HER2/HER3 heterodimer induces one of themost important mitogenic signals via the PI3K and AKT pathway among HERfamily members (Sliwkowski M. X., et al, J. Biol. Chem. 269 (1994)14661-14665; Alimandi M, et al, Oncogene. 10 (1995) 1813-1821; Hellyer,N. J., J. Biol. Chem. 276 (2001) 42153-4261; Singer, E., J. Biol.

In one embodiment, the human ERBB3 protein comprises the following aminoacid sequence provided in GenBank AAH02706.1 and set forth in SEQ ID NO:1:

MRANDALQVLGLLFSLARGSEVGNSQAVCPGTLNGLSVTGDAENQYQTLYKLYERCEVVMGNLEIVLTGHNADLSFLQWIREVTGYVLVAMNEFSTLPLPNLRVVRGTQVYDGKFAIFVMLNYNTNSSHALRQLRLTQLTEILSGGVYIEKNDKLCHMDTIDWRDIVRDRDAEIVVKDNGRSCPPCHEVCKGRCWGPGSEDCQTLTKTICAPQCNGHCFGPNPNQCCHDECAGGCSGPQDTDCFACRHFNDSGACVPRCPQPLVYNKLTFQLEPNPHTKYQYGGVCVASCPHNFVVDQTSCVRACPPDKMEVDKNGLKMCEPCGGLCPKAF (SEQ ID NO: 1).It is to be understood that the ERBB3 (HER3) sequence targeted by theantibody of the present methods and compositions may be an isomer,homolog, or variant of SEQ ID NO: 1.

In one embodiment, the mAb of the recombinant fusion protein providedherein is an anti-Her3 mAb that inhibits NRG-1 signaling through ErbB3(HER3).

In a particular embodiment, the mAb comprised by the recombinant fusionprotein of the invention comprises an anti-HER3 mAb. Such anti-HER3antibodies may include, but are not limited to the following:patritumab, seribantumab (fully human mAb), LJM716, KTN3379, AV-203,REGN1400, GSK2849330, or MM-141. Such antibodies may be also be selectedfrom any of the following forms, including, chimeric, bi-specific,non-human, fully human, or humanized form, so long as they bind to andinhibit signaling from human ERBB3 (HER3). In some embodiments, theanti-HER3 antibody is of human origin.

In some embodiments, the term “antibody” encompasses the various formsof antibody structures including, but not being limited to, wholeantibodies and antibody fragments. The antibody according to theinvention is preferably a human antibody, humanized antibody, chimericantibody, or further genetically engineered antibody as long as thecharacteristic properties according to the invention are retained.“Antibody fragments” comprise a portion of a full length antibody,preferably the variable domain thereof, or at least the antigen bindingsite thereof. Examples of antibody fragments include diabodies,single-chain antibody molecules, and multispecific antibodies formedfrom antibody fragments. scFv antibodies are, e.g., described in Huston,J. S., Methods in Enzymol. 203 (1991) 46-88. In addition, antibodyfragments comprise single chain polypeptides having the characteristicsof a V_(H) domain, namely being able to assemble together with a V_(L)domain, or of a V_(L) domain binding to the respective antigen beingable to assemble together with a V_(H) domain to a functional antigenbinding site and thereby providing the properties of an antibodyaccording to the invention. The terms “monoclonal antibody” or“monoclonal antibody composition” as used herein refer to a preparationof antibody molecules of a single amino acid composition.

In some embodiments, a chimeric antibody may be used in the compositionsand methods provided herein. In one embodiment, the term “chimericantibody” refers to a monoclonal antibody comprising a variable region,i.e., binding region, from mouse and at least a portion of a constantregion derived from a different source or species, usually prepared byrecombinant DNA techniques. Chimeric antibodies comprising a mousevariable region and a human constant region are especially preferred.Such rat/human chimeric antibodies are the product of expressedimmunoglobulin genes comprising DNA segments encoding rat immunoglobulinvariable regions and DNA segments encoding human immunoglobulin constantregions. Other forms of “chimeric antibodies” encompassed by the presentinvention are those in which the class or subclass has been modified orchanged from that of the original antibody. Such “chimeric” antibodiesare also referred to as “class-switched antibodies.” Methods forproducing chimeric antibodies involve conventional recombinant DNA andgene transfection techniques now well known in the art. See, e.g.,Morrison, S. L., et al, Proc. Natl. Acad Sci. USA 81 (1984) 6851-6855;U.S. Pat. Nos. 5,202,238 and 5,204,244.

In one embodiment, a humanized antibody may be used in the compositionsand methods provided herein. In some embodiments, the term “humanizedantibody” or “humanized version of an antibody” refers to antibodies inwhich the framework or “complementarity determining regions” (CDR) havebeen modified to comprise the CDR of an immunoglobulin of differentspecificity as compared to that of the parent immunoglobulin. In otherembodiments, the CDRs of the VH and VL are grafted into the frameworkregion of human antibody to prepare the “humanized antibody.” See e.g.Riechmann, L., et al, Nature 332 (1988) 323-327; and Neuberger, M. S.,et al, Nature 314 (1985) 268-270. The heavy and light chain variableframework regions can be derived from the same or different humanantibody sequences. The human antibody sequences can be the sequences ofnaturally occurring human antibodies. Human heavy and light chainvariable framework regions are listed e.g. in Lefranc, M.-P., CurrentProtocols in Immunology (2000)—Appendix IP A.1P.1-A.1P.37 and areaccessible via IMGT, the international ImMunoGeneTics informationsystem® (http://imgt.cines.fr) or via http://vbase.mrc-cpe.cam.ac.uk.Optionally the framework region can be modified by further mutations.Particularly preferred CDRs correspond to those representing sequencesrecognizing the antigens noted above for chimeric antibodies. The term“humanized antibody” as used herein also comprises such antibodies whichare modified in the constant region to generate the properties accordingto the invention, especially in regard to complement component 1q (C1q)binding and/or Fc Receptor (FcR) binding, e.g. by “class switching” i.e.change or mutation of Fc parts (e.g. from IgG1 to IgG4 and/or IgG1/IgG4mutation). The term “human antibody”, as used herein, is intended toinclude antibodies having variable and constant regions derived fromhuman germ line immunoglobulin sequences. Human antibodies arewell-known in the state of the art (van Dijk, M. A., and van de Winkel,J. G., Curr. Opin. Chem. Biol. 5 (2001) 368-374). Human antibodies canalso be produced in transgenic animals (e.g., mice) that are capable,upon immunization, of producing a full repertoire or a selection ofhuman antibodies in the absence of endogenous immunoglobulin production.Transfer of the human germ-line immunoglobulin gene array in suchgerm-line mutant mice will result in the production of human antibodiesupon antigen challenge (see, e.g., Jakobovits, A., et al, Proc. Natl.Acad. Sci. USA 90 (1993) 2551-2555; Jakobovits, A., et al, Nature 362(1993) 255-258; Brueggemann, M. D., et al., Year Immunol. 7 (1993)33-40). Human antibodies can also be produced in phage display libraries(Hoogenboom, H. R., and Winter, G., J. Mol. Biol. 227 (1992) 381-388;Marks, J. D., et al, J. Mol. Biol. 222 (1991) 581-597). The techniquesof Cole, A., et al. and Boerner, P., et al. are also available for thepreparation of human monoclonal antibodies (Cole, A., et al., MonoclonalAntibodies and Cancer Therapy, Liss, A. L., p. 77 (1985); and Boerner,P., et al, J. Immunol. 147 (1991) 86-95). As already mentioned forhumanized antibodies according to the invention the term “humanantibody” as used herein also comprises such antibodies which aremodified in the constant region to generate the properties according tothe invention.

In one particular embodiment of the present invention, the mAb comprisedby the recombinant fusion protein provided herein comprises at least onemutation in the Fc domain or region.

The term “recombinant human antibody”, as used herein, is intended toinclude all human antibodies that are prepared, expressed, created orisolated by recombinant means, such as antibodies isolated from a hostcell, for example a NSO or CHO cell or from an animal (e.g. a mouse)that is transgenic for human immunoglobulin genes or antibodiesexpressed using a recombinant expression vector transfected into a hostcell. Such recombinant human antibodies have variable and constantregions in a rearranged form. The recombinant human antibodies accordingto the invention have been subjected to in vivo somatic hypermutation.Thus, the amino acid sequences of the VH and VL regions of therecombinant antibodies are sequences that, while derived from andrelated to human germ line VH and VL sequences, may not naturally existwithin the human antibody germ line repertoire in vivo.

In some embodiments, the terms “which binds to human HER3”, “whichspecifically binds to human HER3”, or “anti-HER3 antibody” areinterchangeable and refer to an antibody which specifically binds to thehuman HER3 antigen with a KD-value of about 4.81x⁻¹⁰ mol/L or lower at25° C. The binding affinity is determined with a standard binding assayat 25° C., such as surface plasmon resonance technique (BIAcore®,GE-Healthcare Uppsala, Sweden). Thus an “antibody which binds to humanHER3” as used herein refers to an antibody or portion thereofspecifically which binds to the human HER3 antigen with a bindingaffinity within a range of KD 1.0×10⁻⁸ mol/L-1.0×10⁻¹³ mol/L) at 25° C.,and preferably with a KD-value of 4.81x⁻¹⁰ mol/L or lower at 25° C.

In another aspect, an anti-HER3 antibody comprised by the recombinantfusion protein disclosed herein comprises a variable region heavy (VH)chain and a variable region light (VL) chain. In one embodiment, theantibody comprises the VH and VL sequences in SEQ ID NO: 2 and SEQ IDNO: 3, respectively; and has one or more of the following properties:inhibition of HER3 phosphorylation in tumor cells, inhibition of AKTphosphorylation in tumor cells, inhibition of signaling through ErbB3(HER3), and inhibition of the proliferation of tumor cells.

In one embodiment, the anti-HER3 mAb provided herein comprises a VHamino acid sequence set forth in SEQ ID NO: 2:

Heavy Chain: (SEQ ID NO: 2) QVQLQQWGAG LLKPSETLSL TCAVYGGSFS GYYWSWIRQPPGKGLEWIGE INHSGSTNYN PSLKSRVTIS VETSKNQFSLKLSSVTAADT AVYYCARDKW TWYFDLWGRG TLVTVSSASTKGPSVFPLAP SSKSTSGGTA ALGCLVKDYF PEPVTVSWNSGALTSGVHTF PAVLQSSGLY SLSSVVTVPS SSLGTQTYICNVNHKPSNTK VDKRVEPKSC DKTHTCPPCP APEFLGGPAVFLFPPKPKDT LMISRTPEVT CVVVDVSHED PEVKFNWYVDGVEVHNAKTK PREEQYNSTY RVVSVLTVLH QDWLNGKEYKCKVSNKALPA PIEKTISKAK GQPREPQVYT LPPSREEMTKNQVSLTCLVK GFYPSDIAVE WESNGQPENN YKTTPPVLDSDGSFFLYSKL TVDKSRWQQG NVFSCSVMHE ALHAHYTQKS LSLSPGK.

In one embodiment, the anti-HER3 mAb provided herein comprises a VLamino acid sequence of SEQ ID NO: 3:

Light Chain: (SEQ ID NO: 3) DIEMTQSPDS LAVSLGERAT INCRSSQSVL YSSSNRNYLAWYQQNPGQPP KLLIYWASTR ESGVPDRFSG SGSGTDFTLTISSLQAEDVA VYYCQQYYST PRTFGQGTKV EIKRTVAAPSVFIFPPSDEQ LKSGTASVVC LLNNFYPREA KVQWKVDNALQSGNSQESVT EQDSKDSTYS LSSTLTLSKA DYEKHKVYAC EVTHQGLSSP VTKSFNRGEC.

In one embodiment, the anti-HER3 antibody of the present inventioncomprises at least one mutation in the Fc region. In another embodiment,the mature anti-HER3 antibody (i.e.—lacking a signal peptide) of thepresent invention comprises at least one mutation in amino acids 234,239, 434, or a combination thereof, where in other embodiments, theamino acid mutations comprise at least one of the following substitutionmutations: L234F, S239A, N434A or a combination thereof. In anotherembodiment, mutations to amino acids 234 and/or 239 knock down effectorfunctions of the anti-HER3 antibody. In another embodiment, a mutationto amino acid 434 extends the half-life of the antibody in a subject.

In some embodiments, the one or more mutations in the Fc region reduceeffector function. In some embodiments, the reduced effector functioncomprises a reduced affinity of the anti-HER3 antibody for one or moreFc Receptors. The FcRs can be FcγRI, FcγRIIa, FcγRIIb, FcγRIIIa (158F),FcγRIIIa (158V) and C1q. In some embodiments, the reduced affinitycomprising an increase in dissociation constant of about 1 order ofmagnitude or greater. In some embodiments, introducing one or more Fcmutations increases the KD of the anti-HER3 antibody of fusion proteincomprising same for FcγRI from 2.81×10⁻⁹M to 1.03×10⁻⁸ M. In someembodiments, introducing one or more Fc mutations increases the KD ofthe anti-HER3 antibody of fusion protein comprising same for FcγRIIafrom 3.95×10⁻⁷ M to 1.35×10⁻⁶ M. In some embodiments, introducing one ormore Fc mutations increases the KD of the anti-HER3 antibody of fusionprotein comprising same for FcγRIIb from 1.03×10⁻⁷ M to 1.52×10⁻⁶ M. Insome embodiments, introducing one or more Fc mutations increases the KDof the anti-HER3 antibody of fusion protein comprising same for FcγRIIIa(158F) from 6.37×10⁻⁸ M to 1.18×10⁻⁷M. In some embodiments, introducingone or more Fc mutations increases the KD of the anti-HER3 antibody offusion protein comprising same for FcγRIIIa (158V) from 3.41 ×10⁻⁸ M to9.10×10⁻⁸ M.

In some embodiments, the anti-HER3 antibody or recombinant fusionprotein comprising same binds to FcγRI with an equilibrium dissociationconstant (KD) higher than or equal to 1.03×10⁻⁸ M. In some embodiments,the anti-HER3 antibody or recombinant fusion protein comprising samecomprises one or more Fc mutations and binds to FcγRIIa with a KD higherthan or equal to 1.35×10⁻⁶ M. In some embodiments, the anti-HER3antibody or recombinant fusion protein comprising same comprises one ormore Fc mutations and binds to FcγRIIb with a KD higher than or equal to1.5 ×10⁻⁶ M. In some embodiments, the anti-HER3 antibody or recombinantfusion protein comprising same comprises one or more Fc mutations andbinds to FcγRIIIa (158F) with a KD higher than or equal to 1.18×10⁻⁷ M.In some embodiments, the anti-HER3 antibody or recombinant fusionprotein comprising same comprises one or more Fc mutations and binds toFcγRIIIa (158V) with a KD higher than or equal to 9.10×10⁻⁸ M.

The term “antibody effector function(s)” as used herein refers to afunction contributed by an Fc region(s) of an Ig. Such function can beaffected by, for example, binding of an Fc effector region (s) to an Fcreceptor on an immune cell with phagocytic or lytic activity or bybinding of an Fc effector region(s) to components of the complementsystem.

In one embodiment, the anti-HER3 antibody does not induceantibody-dependent cellular cytotoxicity (ADCC). The term“antibody-dependent cellular cytotoxicity (ADCC)” refers to lysis ofhuman target cells by an antibody according to the invention in thepresence of effector cells.

In one embodiment of the invention, the antibody according to theinvention is glycosylated. In some embodiments, the glycosylation isN-glycosylation. In other embodiments, the glycosylation isO-glycosylation.

In the context of the recombinant fusion protein provided herein andaccording to the invention, the antibodies comprised by the recombinantfusion protein may be produced via recombinant means. Such methods arewidely known in the state of the art and comprise protein expression inprokaryotic and eukaryotic cells with subsequent isolation of theantibody polypeptide and usually purification to a pharmaceuticallyacceptable purity. For the protein expression nucleic acids encodinglight and heavy chains or fragments thereof are inserted into expressionvectors by standard methods. Expression is performed in appropriateprokaryotic or eukaryotic host cells, such as CHO cells, NSO cells,SP2/0 cells, HEK293 cells, COS cells, yeast, or E. coli cells, and theantibody is recovered from the cells (from the supernatant or aftercells lysis). Recombinant production of antibodies is well-known in thestate of the art and described, for example, in the review articles ofMakrides, S. C., Protein Expr. Purif. 17 (1999) 183-202; Geisse, S., etal, Protein Expr. Purif 8 (1996) 271-282; Kaufman, R. J., Mol.Biotechnol. 16 (2000) 151-161; Werner, R. G., Drug Res. 48 (1998)870-880. The antibodies may be present in whole cells, in a cell lysate,or in a partially purified, or substantially pure form. Purification isperformed in order to eliminate other cellular components or othercontaminants, e.g., other cellular nucleic acids or proteins, bystandard techniques, including, column chromatography and others wellknown in the art (see Ausubel, F., et al, ed. Current Protocols inMolecular Biology, Greene Publishing and Wiley Interscience, New York(1987)). Expression in NSO cells is described by, e.g., Barnes, L. M.,et al, Cytotechnology 32 (2000) 109-123; Barnes, L. M., et al, Biotech.Bioeng. 73 (2001) 261-270. Transient expression is described by, e.g.,Durocher, Y., et al, Nucl. Acids. Res. 30 (2002) E9. Cloning of variabledomains is described by Orlandi, R., et al, Proc. Natl. Acad. Sci. USA86 (1989) 3833-3837; Carter, P., et al, Proc. Natl. Acad. Sci. USA 89(1992) 4285-4289; Norderhaug, L., et al, J. Immunol. Methods 204 (1997)77-87. A preferred transient expression system (HEK 293) is described bySchlaeger, E.-J. and Christensen, K., in Cytotechnology 30 (1999) 71-83,and by Schlaeger, E.-J., in J. Immunol. Methods 194 (1996) 191-199.Monoclonal antibodies are suitably separated from the culture medium byconventional immunoglobulin purification procedures such as, forexample, protein A-Sepharose, hydroxylapatite chromatography, gelelectrophoresis, dialysis, or affinity chromatography. DNA and RNAencoding the monoclonal antibodies is readily isolated and sequencedusing conventional procedures. The hybridoma cells can serve as a sourceof such DNA and RNA. Once isolated, the DNA may be inserted intoexpression vectors, which are then transfected into host cells, such asHEK 293 cells, CHO cells, or myeloma cells that do not otherwise produceimmunoglobulin protein, to obtain the synthesis of recombinantmonoclonal antibodies in the host cells.

The heavy and light chain variable domains according to the inventionare combined with sequences of promoter, translation initiation,constant region, 3′ untranslated region, polyadenylation, andtranscription termination to form expression vector constructs. Theheavy and light chain expression constructs can be combined into asingle vector, co-transfected, serially transfected, or separatelytransfected into host cells which are then fused to form a single hostcell expressing both chains.

It is self-evident that the antibodies are administered to the subjectin therapeutically effective amount which is the amount of the subjectcompound or combination that will elicit the biological or medicalresponse of a tissue, system, animal or human that is being sought bythe researcher, veterinarian, medical doctor or other clinician.

Recombinant Fusion Protein—Neuregulin

In one embodiment, the recombinant fusion protein provided hereincomprises a fragment of an NRG-1 protein. NRG proteins can bind to theErbB4 receptor on the surface of myocardial cells, continuously activatethe PI3K/AKT signal pathway in the cell, and change the structure of themyocardial cells, thereby improving the function of myocardial cells.

As used herein, “neuregulin” or “NRG” refers to proteins or peptidesthat can bind and activate ErbB3, ErbB4 or heterodimers or homodimersthereof, including neuregulin isoforms, neuregulin EGF-like domain,polypeptides comprising neuregulin EGF-like domain, neuregulin mutantsor derivatives, and any kind of neuregulin-like gene products that canactivate the above receptors Neuregulin also includes NRG-1, NRG-2,NRG-3 and NRG-4 proteins, peptides, fragments and compounds that havethe functions of neuregulin. In preferred embodiments, neuregulin is aprotein or peptide that can bind to and activate ErbB2/ErbB4 orErbB2/ErbB3 heterodimers, for example, but not for the purpose ofrestriction, peptides of the present invention includes a fragment ofthe NRG-1β2 isoform, i.e., the 177-237 amino acid fragment, whichcontains the EGF-like domain having the following amino acid sequence:SHLVKCAEKEKTFCVNGGECFMVKDLSNPSRYLCKCPNEFTGDRCQNYVMASFYK AEELYQ (SEQ IDNO: 4). The NRG proteins of the present invention can activate thereceptors above and regulate their biological functions, for example,stimulate the synthesis of acetylcholine receptors in skeletal musclecells, promote the differentiation and survival of cardiomyocytes andDNA synthesis. It is well known to those of skill in this art that amutation of a single amino acid in a non-critical region generally wouldnot alter the biological activity of the resulting protein orpolypeptide (see, e.g., Watson et al., Molecular Biology of the Gene,4th Edition, 1987, The Bejacmin/Cummings Pub.co., p. 224). The NRGproteins of the invention can be isolated from natural sources, may bemodified through recombination technology, artificial synthesis or othermeans.

As used herein, “epidermal growth factor-like domain” or “EGF-likedomain” refers to a polypeptide fragment encoded by the neuregulin genethat binds to and activates ErbB3, ErbB4, or heterodimers or homodimersthereof and including heterodimers with ErbB2, and structurally similarto the EGF receptor binding region as described in WO 00/64400, Holmeset al., Science, 256:1205-1210 (1992); U.S. Pat. Nos. 5,530,109 and5,716,930; Hijazi et al., Int. J. Oncol., 13:1061-1067 (1998); Chang etal., Nature, 387:509-512 (1997); Carraway et al., Nature, 387:512-516(1997); Higashiyama et al., J. Biochem., 122:675-680 (1997); and WO97/09425, the contents of which are all incorporated herein byreference. In certain embodiments, EGF-like domain binds to andactivates ErbB2/ErbB4 or ErbB2/ErbB3 heterodimers. In certainembodiments, EGF-like domain comprises the amino acid sequence of thereceptor binding domain of NRG-1. In some embodiments, EGF-like domainrefers to amino acid residues 177-226, 177-237, or 177-240 of NRG-1. Incertain embodiments, EGF-like domain comprises the amino acid sequenceof the receptor binding domain of neuregulin-2 (NRG-2, also known in theart as DON1, HRG2 and NTAK). In certain embodiments, an EGF-like domainof NRG-2 comprises a sequence ofHARKCNETAKSYCVNGGVCYYIEGINQLSCKCPNGFFGQRCL (SEQ ID NO: 15). In certainembodiments, EGF-like domain comprises the amino acid sequence of thereceptor binding domain of neuregulin 3 (NRG-3, also known in the art asHRG3 and pro-NRG3). In certain embodiments, the EGF-like domain of NRG-3comprises a sequence of HFKPCRDKDLAYCLNDGECFVIETLTGSHKHCRCKEGYQGVRCD(SEQ ID NO: 16). In certain embodiments, EGF-like domain comprises theamino acid sequence of the receptor binding domain of neuregulin 4(NRG-4, also known in the art as HER4). In certain embodiments, anEGF-like domain of NRG-4 comprises a sequence ofHEEPCGPSHKSFCLNGGLCYVIPTIPSPFCRCVENYTGARCE (SEQ ID NO: 17). In certainembodiments, EGF-like domain comprises the amino acid sequence of AlaGlu Lys Glu Lys Thr Phe Cys Val Asn Gly Glu Cys Phe Met Val Lys Asp LeuSer Asn Pro (SEQ ID NO: 18), as described in U.S. Pat. No. 5,834,229.

In one embodiment, the NRG-1 protein provided in the recombinant fusionprotein disclosed herein is the NRG-1 β2a isoform.

In some embodiments, the active NRG-1 fragment comprises the ERBB3/4binding domain. In another related embodiment, the NRG-1 binds to andinduces signaling through ErbB4 (HER4). In other embodiments, the mAbinhibits NRG-1 signaling through ErbB3 (HER3). In some embodiments, theactive protein fragment of NRG-1 comprises the active domain of NRG-1.

Recombinant Fusion Protein—Compositions

In one embodiment, in the recombinant fusion protein disclosed hereinthe NRG-1 is fused to the C-terminus of the anti-HER3 antibody heavychain using a linker. In another related aspect, NRG-1 is attached tothe linker via the first (1^(st)) amino acid on the N-terminus of NRG-1,which in one embodiment is a Serine (S or Ser) amino acid. The specificrecombinant fusion protein utilized in the current invention may beoptionally obtained or created by any method known in the art (includingpurchase from commercial sources). For example, nucleic acid sequencesencoding the appropriate antibody framework are optionally cloned andligated into appropriate vectors (e.g., expression vectors for, e.g.,prokaryotic or eukaryotic organisms). Additionally, nucleic acidsequences encoding the NRG-1 β2a isoform molecule are optionally clonedinto the same vector in the appropriate orientation and location so thatexpression from the vector produces an antibody-NRG-1 β2a isoform fusionprotein. Some optional embodiments also require post-expressionmodification, e.g., assembly of antibody subunits, etc. The techniquesand art for the above (and similar) manipulations are well known tothose skilled in the art. Pertinent instructions are found in, e.g.,Sambrook et al., Molecular Cloning—A Laboratory Manual (2nd Ed.), Vols.1-3, Cold Spring Harbor Laboratory, Cold Spring Harbor, N.Y., 1989 andCurrent Protocols in Molecular Biology, F. M. Ausubel et al., eds.,Current Protocols, a joint venture between Greene Publishing Associates,Inc. and John Wiley & Sons, Inc. (supplemented through 1999). In somealternate embodiments, the antibody domain and NRG-1 β2a isoform areassembled post-expression through, e.g., chemical means. In oneembodiment, the present invention provides a composition, e.g. apharmaceutical composition comprising the recombinant fusion protein ofthe present invention.

In one embodiment, the recombinant fusion protein promotes cardiomyocyteproliferation, differentiation, and survival. In another embodiment, therecombinant fusion protein promotes proliferation, differentiation andsurvival of cardiac tissue. In one embodiment, the recombinant fusionprotein promotes cardiomyocyte proliferation, differentiation, andsurvival without promoting cancer and/or tumor growth. In anotherembodiment, the recombinant fusion protein promotes proliferation,differentiation and survival of cardiac tissue without promoting canceror tumor growth.

In one embodiment, the cancer is adrenocortical carcinoma, AIDS-relatedcancers, AIDS-related lymphoma, anal cancer, anorectal cancer, cancer ofthe anal canal, appendix cancer, childhood cerebellar astrocytoma,childhood cerebral astrocytoma, basal cell carcinoma, skin cancer(non-melanoma), biliary cancer, extrahepatic bile duct cancer,intrahepatic bile duct cancer, bladder cancer, urinary bladder cancer,bone and joint cancer, osteosarcoma and malignant fibrous histiocytoma,brain cancer, brain tumor, brain stem glioma, cerebellar astrocytoma,cerebral astrocytoma/malignant glioma, ependymoma, medulloblastoma,supratentorial primitive neuroectodermal tumors, visual pathway andhypothalamic glioma, breast cancer, bronchial adenomas/carcinoids,carcinoid tumor, gastrointestinal, nervous system cancer, nervous systemlymphoma, central nervous system cancer, central nervous systemlymphoma, cervical cancer, childhood cancers, chronic lymphocyticleukemia, chronic myelogenous leukemia, chronic myeloproliferativedisorders, colon cancer, colorectal cancer, cutaneous T-cell lymphoma,lymphoid neoplasm, mycosis fungoides, Seziary Syndrome, endometrialcancer, esophageal cancer, extracranial germ cell tumor, extragonadalgerm cell tumor, extrahepatic bile duct cancer, eye cancer, intraocularmelanoma, retinoblastoma, gallbladder cancer, gastric (stomach) cancer,gastrointestinal carcinoid tumor, gastrointestinal stromal tumor (GIST),germ cell tumor, ovarian germ cell tumor, gestational trophoblastictumor glioma, head and neck cancer, hepatocellular (liver) cancer,Hodgkin lymphoma, hypopharyngeal cancer, intraocular melanoma, ocularcancer, islet cell tumors (endocrine pancreas), Kaposi Sarcoma, kidneycancer, renal cancer, kidney cancer, laryngeal cancer, acutelymphoblastic leukemia, acute myeloid leukemia, chronic lymphocyticleukemia, chronic myelogenous leukemia, hairy cell leukemia, lip andoral cavity cancer, liver cancer, lung cancer, non-small cell lungcancer, small cell lung cancer, AIDS-related lymphoma, non-Hodgkinlymphoma, primary central nervous system lymphoma, Waldenstroemmacroglobulinemia, medulloblastoma, melanoma, intraocular (eye)melanoma, merkel cell carcinoma, mesothelioma malignant, mesothelioma,metastatic squamous neck cancer, mouth cancer, cancer of the tongue,multiple endocrine neoplasia syndrome, mycosis fungoides,myelodysplastic syndromes, myelodysplastic/myeloproliferative diseases,chronic myelogenous leukemia, acute myeloid leukemia, multiple myeloma,chronic myeloproliferative disorders, nasopharyngeal cancer,neuroblastoma, oral cancer, oral cavity cancer, oropharyngeal cancer,ovarian cancer, ovarian epithelial cancer, ovarian low malignantpotential tumor, pancreatic cancer, islet cell pancreatic cancer,paranasal sinus and nasal cavity cancer, parathyroid cancer, penilecancer, pharyngeal cancer, pheochromocytoma, pineoblastoma andsupratentorial primitive neuroectodermal tumors, pituitary tumor, plasmacell neoplasm/multiple myeloma, pleuropulmonary blastoma, prostatecancer, rectal cancer, renal pelvis and ureter, transitional cellcancer, retinoblastoma, rhabdomyosarcoma, salivary gland cancer, Ewingfamily of sarcoma tumors, Kaposi Sarcoma, soft tissue sarcoma,epithelioid sarcoma, synovial sarcoma, uterine cancer, uterine sarcoma,skin cancer (non-melanoma), skin cancer (melanoma), merkel cell skincarcinoma, small intestine cancer, soft tissue sarcoma, squamous cellcarcinoma, stomach (gastric) cancer, supratentorial primitiveneuroectodermal tumors, testicular cancer, throat cancer, thymoma,thymoma and thymic carcinoma, thyroid cancer, transitional cell cancerof the renal pelvis and ureter and other urinary organs, gestationaltrophoblastic tumor, urethral cancer, endometrial uterine cancer,uterine sarcoma, uterine corpus cancer, vaginal cancer, vulvar cancer,or Wilm's Tumor.

In another embodiment, the recombinant fusion protein promotesproliferation, differentiation and survival of central nervous system(CNS) cells. In another embodiment, the recombinant fusion proteinpromotes proliferation, differentiation and survival of central nervoussystem (CNS) cells without promoting cancer and/or tumor growth. Inanother embodiment, the recombinant fusion protein has a reducedcapacity to induce antibody-dependent cell cytotoxicity (ADCC).

In some embodiments, the recombinant fusion protein promotes HER2/4signaling over HER2/3 signaling relative to the signal inductionpotential of recombinant NRG-1.

In a particular embodiment of the invention, the recombinant fusionprotein comprises an anti-HER3mAb fused to or operably linked to theC-terminus of the antibody heavy chain via a GGGGSGGGGS (G45) linker(SEQ ID NO: 5) to the NRG-1 β2a isoform of SEQ ID NO: 4. In someembodiments, one or more copies of the linker may be used. In otherembodiments, 2, 3, 4, or 5 copies of the G45 linker or any other linkerknown in the art as being suitable for the composition disclosed hereinmay be used herein.

The term “linker” is art-recognized and refers to a molecule (includingbut not limited to unmodified or modified nucleic acids or amino acids)or group of molecules (for example, 2 or more, e.g., 2, 3, 4, 5, 6, 7,8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85,90, 95, 100 or more) connecting two compounds, such as two polypeptides.The linker may be comprised of a single linking molecule or may comprisea linking molecule and at least one spacer molecule, intended toseparate the linking molecule and a compound by a specific distance.

A nucleic acid sequence is “operably linked” when it is placed into afunctional relationship with another nucleic acid sequence. For example,a nucleic acid presequence or secretory leader is operably linked to anucleic acid encoding a polypeptide if it is expressed as a preproteinthat participates in the secretion of the polypeptide; a promoter orenhancer is operably linked to a coding sequence if it affects thetranscription of the sequence; or a ribosome binding site is operablylinked to a coding sequence if it is positioned so as to facilitatetranslation. Generally, “operably linked” means that the nucleic acidsequences being linked are contiguous, and, in the case of a secretoryleader, contiguous and in reading frame. However, enhancers areoptionally contiguous. Linking can be accomplished, for example, byligation at convenient restriction sites. If such sites do not exist,synthetic oligonucleotide adaptors, linkers or other methods known inthe art can be used. In another embodiment, the “operably linked” alsorefers to the functional pairing of distinct amino acid sequences,peptides or proteins, as in the pairing of the antibody and NRG-1fragment described herein via a linker sequence also described herein.

In another embodiment, the anti-HER3 mAb heavy chain comprised by therecombinant fusion protein provided herein is encoded by SEQ ID NO: 6:ATGGAGTTTGGGCTGAGCTGGGTTTTCCTTGTTGCTATAATAAAAGGTGTCCAGTGTCAGGTGCAGCTGCAGCAGTGGGGAGCTGGACTGCTGAAGCCAAGCGAGACCCTGTCTCTGACATGCGCCGTGTACGGAGGATCCTTCAGCGGATACTATTGGTCTTGGATCAGGCAGCCACCTGGCAAGGGACTGGAGTGGATCGGCGAGATCAACCACTCTGGCTCCACCAACTACAATCCCTCTCTGAAGTCCCGGGTGACCATCTCCGTGGAGACAAGCAAGAATCAGTTTTCCCTGAAGCTGTCCAGCGTGACCGCCGCTGACACAGCCGTGTACTATTGCGCTAGGGACAAGTGGACCTGGTATTTCGATCTGTGGGGAAGGGGCACCCTGGTGACAGTGTCTTCCGCCTCTACAAAGGGCCCCTCCGTGTTTCCTCTGGCTCCAAGCTCTAAGAGCACCTCTGGAGGAACAGCCGCTCTGGGATGTCTGGTGAAGGATTACTTCCCTGAGCCAGTGACCGTGAGCTGGAACTCTGGCGCCCTGACCTCCGGAGTGCATACATTTCCCGCTGTGCTGCAGTCCAGCGGCCTGTATAGCCTGTCTTCCGTGGTGACCGTGCCTAGCTCTTCCCTGGGCACCCAGACATACATCTGCAACGTGAATCACAAGCCCTCCAATACAAAGGTGGACAAGAGAGTGGAGCCTAAGAGCTGTGATAAGACCCATACATGCCCACCATGTCCAGCTCCTGAGCTGCTGGGAGGACCTTCCGTGTTCCTGTTTCCTCCAAAGCCAAAGGACACCCTGATGATCTCTCGCACCCCTGAGGTGACATGCGTGGTGGTGGACGTGTCCCACGAGGATCCAGAGGTGAAGTTCAACTGGTACGTGGATGGCGTGGAGGTGCATAATGCTAAGACCAAGCCTAGGGAGGAGCAGTACAACAGCACCTATCGGGTGGTGTCTGTGCTGACAGTGCTGCACCAGGACTGGCTGAACGGCAAGGAGTACAAGTGCAAGGTGAGCAATAAGGCCCTGCCAGCTCCCATCGAGAAGACCATCTCTAAGGCCAAGGGCCAGCCCAGAGAGCCTCAGGTGTATACACTGCCCCCTAGCCGCGAGGAGATGACCAAGAACCAGGTGTCTCTGACATGTCTGGTGAAGGGCTTCTACCCATCTGACATCGCTGTGGAGTGGGAGTCCAATGGCCAGCCCGAGAACAATTATAAGACCACACCACCCGTGCTGGACTCCGATGGCAGCTTCTTTCTGTACTCCAAGCTGACCGTGGATAAGAGCAGGTGGCAGCAGGGCAACGTGTTTTCCTGCAGCGTGATGCACGAGGCCCTGCACAATCATTATACACAGAAATCTCTGTCCCTGAGCCCAGGCAAGGGAGGAGGAGGAAGCGGAGGAGGAGGCAGCTCTCATCTGGTGAAGTGTGCTGAGAAGGAGAAGACCTTCTGCGTGAACGGCGGCGAGTGTTTTATGGTGAAGGACCTGTCTAATCCATCCAGATACCTGTGCAAGTGTCCCAACGAGTTCACAGGCGATCGCTGCCAGAATTACGTGATGGCCTCTTTTTATAAGGCTGAGGAGCTGTACCAGTAA (SEQ ID NO: 6). In one embodiment,the sequence set forth in SEQ ID NO: 6 comprises no Fc mutations. In oneembodiment, SEQ ID NO: 6 is also referred to as “NPCF”.

In one embodiment, the recombinant fusion protein provided hereincomprises a heavy chain of an anti-HER3 mAb. In another embodiment, theanti-HER3 mAb heavy chain is encoded by SEQ ID NO: 7:ATGGAGTTTGGGCTGAGCTGGGTTTTCCTTGTTGCTATAATAAAAGGTGTCCAGTGTCAGGTGCAGCTGCAGCAGTGGGGAGCTGGACTGCTGAAGCCAAGCGAGACCCTGTCTCTGACATGCGCCGTGTACGGAGGATCCTTCAGCGGATACTATTGGTCTTGGATCAGGCAGCCACCTGGCAAGGGACTGGAGTGGATCGGCGAGATCAACCACTCTGGCTCCACCAACTACAATCCCTCTCTGAAGTCCCGGGTGACCATCTCCGTGGAGACAAGCAAGAATCAGTTTTCCCTGAAGCTGTCCAGCGTGACCGCCGCTGACACAGCCGTGTACTATTGCGCTAGGGACAAGTGGACCTGGTATTTCGATCTGTGGGGAAGGGGCACCCTGGTGACAGTGTCTTCCGCCTCTACAAAGGGCCCCTCCGTGTTTCCTCTGGCTCCAAGCTCTAAGAGCACCTCTGGAGGAACAGCCGCTCTGGGATGTCTGGTGAAGGATTACTTCCCTGAGCCAGTGACCGTGAGCTGGAACTCTGGCGCCCTGACCTCTGGAGTGCATACATTTCCCGCTGTGCTGCAGTCCAGCGGCCTGTATAGCCTGTCTTCCGTGGTGACCGTGCCTAGCTCTTCCCTGGGCACCCAGACATACATCTGCAACGTGAATCACAAGCCCTCCAATACAAAGGTGGACAAGAGAGTGGAGCCTAAGAGCTGTGATAAGACCCATACATGCCCACCATGTCCAGCTCCTGAGTTCCTGGGAGGACCTGCCGTGTTCCTGTTTCCTCCAAAGCCAAAGGACACCCTGATGATCTCTCGCACCCCTGAGGTGACATGCGTGGTGGTGGACGTGTCCCACGAGGATCCAGAGGTGAAGTTCAACTGGTACGTGGATGGCGTGGAGGTGCATAATGCTAAGACCAAGCCTAGGGAGGAGCAGTACAACAGCACCTATCGGGTGGTGTCTGTGCTGACAGTGCTGCACCAGGACTGGCTGAACGGCAAGGAGTACAAGTGCAAGGTGAGCAATAAGGCCCTGCCAGCTCCCATCGAGAAGACCATCTCTAAGGCCAAGGGCCAGCCCAGAGAGCCTCAGGTGTATACACTGCCCCCTAGCCGCGAGGAGATGACCAAGAACCAGGTGTCTCTGACCTGTCTGGTGAAGGGCTTCTACCCATCTGACATCGCTGTGGAGTGGGAGTCCAATGGCCAGCCCGAGAACAATTATAAGACCACACCACCCGTGCTGGACTCCGATGGCAGCTTCTTTCTGTACTCCAAGCTGACCGTGGATAAGAGCAGGTGGCAGCAGGGCAACGTGTTTTCCTGCAGCGTGATGCACGAGGCCCTGCACGCTCATTATACACAGAAATCTCTGTCCCTGAGCCCAGGCAAGGGAGGAGGAGGAAGCGGAGGAGGAGGCAGCTCTCATCTGGTGAAGTGTGCTGAGAAGGAGAAGACCTTCTGCGTGAACGGCGGCGAGTGTTTTATGGTGAAGGACCTGTCTAATCCATCCAGATACCTGTGCAAGTGTCCCAACGAGTTCACAGGCGATCGCTGCCAGAATTACGTGATGGCCTCTTTTTATAAGGCTGAGGAGCTGTACCAGTAA (SEQ ID NO: 7). In one embodiment,SEQ ID NO: 7 is also referred to as “NPCFA”. In one embodiment, SEQ IDNO: 7 comprises one or more mutations that encode for one or moremutations in the constant (Fc) region of the anti-HER3 mAb providedherein. In one embodiment, the mature anti-HER3 antibody of the presentinvention comprises at least one mutation in amino acids 234, 239, 434,or a combination thereof. In another embodiment, the amino acidmutations comprise at least one of the following substitution mutations:L234F, S239A, N434A or a combination thereof.

In one embodiment, the recombinant fusion protein provided hereincomprises a light chain sequence of an anti-HER3 mAb. In anotherembodiment, the light chain sequence is encoded by (SEQ ID NO: 8):ATGGTGTTGCAGACCCAGGTCTTCATTTCTCTGTTGCTCTGGATCTCTGGTGCCTACGGGGACATCGAGATGACCCAGTCTCCAGATTCCCTGGCCGTGAGCCTGGGAGAGAGGGCTACAATCAACTGCCGGTCCAGCCAGTCTGTGCTGTACTCTTCCAGCAACAGGAATTACCTGGCCTGGTATCAGCAGAATCCCGGCCAGCCCCCTAAGCTGCTGATCTATTGGGCTAGCACCAGAGAGTCTGGAGTGCCTGACCGCTTCTCTGGATCCGGAAGCGGCACAGACTTCACCCTGACAATCTCTTCCCTGCAGGCCGAGGACGTGGCCGTGTACTATTGCCAGCAGTATTACTCTACCCCTAGGACATTCGGCCAGGGCACCAAGGTGGAGATCAAGCGGACAGTGGCCGCTCCATCCGTGTTCATCTTTCCACCCTCCGACGAGCAGCTGAAGTCCGGAACCGCTAGCGTGGTGTGCCTGCTGAACAACTTCTACCCAAGAGAGGCCAAGGTGCAGTGGAAGGTGGATAACGCTCTGCAGAGCGGCAATTCTCAGGAGTCCGTGACCGAGCAGGACAGCAAGGATTCTACATATTCCCTGAGCTCTACCCTGACACTGTCCAAGGCCGATTACGAGAAGCACAAGGTGTATGCTTGCGAGGTGACCCATCAGGGCCTGTCCAGCCCCGTGACAAAGAGCTTCAACCGCG GCGAGTGTTAA (SEQID NO: 8). In one embodiment, SEQ ID NO: 8 is also referred to as “PAL”.

In one embodiment, the heavy chain of the anti-HER3 antibody comprisedby the recombinant fusion protein provided herein comprises thefollowing amino acid sequence:

(SEQ ID NO: 9) MEFGLSWVFLVAIIKGVQCQVQLQQWGAGLLKPSETLSLTCAVYGGSFSGYYWSWIRQPPGKGLEWIGEINHSGSTNYNPSLKSRVTISVETSKNQFSLKLSSVTAADTAVYYCARDKWTWYFDLWGRGTLVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKSCDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSREEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGKGGGGSGGGGSSHLVKCAEKEKTFCVNGGECFMVKDLSNPSRYLCKCPNEFTGDRCQNYVMASFYKAEELYQ.

In one embodiment, the heavy chain of the anti-HER3 antibody comprisedby the recombinant fusion protein provided herein comprises thefollowing amino acid sequence:

(SEQ ID NO: 10) MEFGLSWVFLVAIIKGVQCQVQLQQWGAGLLKPSETLSLTCAVYGGSFSGYYWSWIRQPPGKGLEWIGEINHSGSTNYNPSLKSRVTISVETSKNQFSLKLSSVTAADTAVYYCARDKWTWYFDLWGRGTLVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKSCDKTHTCPPCPAPEFLGGPAVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSREEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHAHYTQKSLSLSPGKGGGGSGGGGSSHLVKCAEKEKTFCVNGGECFMVKDLSNPSRYLCKCPNEFTGDRCQNYVMASFYKAEELYQ.

In one embodiment, the anti-HER3 mAb heavy chain sequence comprises asignal peptide sequence. In another embodiment, the anti-HER3 mAb heavychain signal peptide sequence comprises the amino acid sequence ofMEFGLSWVFLVAIIKGVQC (SEQ ID NO: 11).

In one embodiment, light chain of the anti-HER3 antibody comprised bythe recombinant fusion protein comprises the following amino acidsequence:

(SEQ ID NO: 12) MVLQTQVFISLLLWISGAYGDIEMTQSPDSLAVSLGERATINCRSSQSVLYSSSNRNYLAWYQQNPGQPPKLLIYWASTRESGVPDRFSGSGSGTDFTLTISSLQAEDVAVYYCQQYYSTPRTFGQGTKVEIKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC.

In one embodiment, the anti-HER3 mAb light chain sequence comprises asignal peptide sequence. In another embodiment, the anti-HER3 mAb lightchain signal peptide sequence comprises the amino acid sequence ofMVLQTQVFISLLLWISGAYG (SEQ ID NO: 13). In one embodiment, a maturepolypeptide such as an antibody heavy chain or light chain amino acidsequence disclosed herein lacks a signal peptide.

In one embodiment, the recombinant fusion protein comprises thefollowing amino acid sequences:

Heavy chain QVQLQQWGAGLLKPSETLSLTCAVYGGSFSGYYWSWIRQPPGKGLEWIGEINHSGSTNYNPSLKSRVTISVETSKNQFSLKLSSVTAADTAVYYCARDKWTWYFDLWGRGTLVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKSCDKTHTCPPCPAPE F LGGP A VFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSREEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALH A HYTQKSLSLSPG K

SHLVKCAEKEKTFCVNGGECFMVKDLSNPSRYLCKCPNEFTGDRCQNYVMASFYKAEELYQ (SEQ ID NO: 14, whereinbold italics indicate the linker, and boldindicates the NRG-1 fragment); and Light chain (SEQ ID NO: 3)DIEMTQSPDSLAVSLGERATINCRSSQSVLYSSSNRNYLAWYQQNPGQPPKLLIYWASTRESGVPDRFSGSGSGTDFTLTISSLQAEDVAVYYCQQYYSTPRTFGQGTKVEIKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYAC EVTHQGLSSPVTKSFNRGEC.

In one embodiment, each of the heavy chain sequence and light chainsequence in the mature recombinant fusion protein lack a signal peptideamino acid sequence.

In a particular embodiment of the invention, the heavy chain of theanti-HER3 antibody provided herein is fused via the C-terminus linkersequence to the NRG-1 β2a isoform provided herein. In anotherembodiment, the C-terminus of the antibody heavy chain comprises the Fcdomain of the antibody.

In some embodiments, provided are pharmaceutical compositions comprisingthe recombinant fusion protein disclosed herein formulated together witha pharmaceutical carrier.

In some embodiments, the anti-HER3 antibody and the NRG-1 fragmentdescribed herein are recombinantly or chemically fused/operably linkedvia a linker to form a fusion protein. A “fusion protein,” “fusionpolypeptide,” “recombinant fusion protein,” or “recombinant polypeptide”refers to a hybrid polypeptide which comprises polypeptide portions fromat least two different polypeptides. A “fusion protein” as definedherein, is a fusion of a first amino acid sequence (protein) comprising,for example an NRG-1 β2a isoform of the invention, joined via a linkerto the C-terminus of a second amino acid sequence comprising an heavychain of an antibody that binds specifically to ERBB3 (HER3).

In one embodiment, the fusion protein is recombinantly encoded andproduced. In some embodiments, the recombinant fusion protein is encodedby a nucleic acid sequence encoding the antibody of the invention thatis operably linked via a nucleic acid sequence encoding a linker, to anucleic acid sequence encoding an NRG-1 β2a isoform of the invention.

In one embodiment, the recombinant fusion protein amino acid sequence ishomologous to SEQ ID NO: 14 fused to SEQ ID NO: 3. The term “homology”may refer to identity to recombinant fusion protein sequence (e.g. toany of SEQ ID NO: 1-18) of greater than 70%. In another embodiment,“homology” refers to identity to any of SEQ ID NO: 1-18 of greater than72%. In another embodiment, “homology” refers to identity to any of SEQID NO: 1-18 of greater than 75%. In another embodiment, “homology”refers to identity to any of SEQ ID NO: 1-18 of greater than 78%. Inanother embodiment, “homology” refers to identity to any of SEQ ID NO:1-18 of greater than 80%. In another embodiment, “homology” refers toidentity to any of SEQ ID NO: 1-18 of greater than 82%. In anotherembodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 ofgreater than 83%. In another embodiment, “homology” refers to identityto any of SEQ ID NO: 1-18 of greater than 85%. In another embodiment,“homology” refers to identity to any of SEQ ID NO: 1-18 of greater than87%. In another embodiment, “homology” refers to identity to any of SEQID NO: 1-18 of greater than 88%. In another embodiment, “homology”refers to identity to any of SEQ ID NO: 1-18 of greater than 90%. Inanother embodiment, “homology” refers to identity to any of SEQ ID NO:1-18 of greater than 92%. In another embodiment, “homology” refers toidentity to any of SEQ ID NO: 1-18 of greater than 93%. In anotherembodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 ofgreater than 95%. In another embodiment, “homology” refers to identityto any of SEQ ID NO: 1-18 of greater than 96%. In another embodiment,“homology” refers to identity to any of SEQ ID NO: 1-18 of greater than97%. In another embodiment, “homology” refers to identity to any of SEQID NO: 1-18 of greater than 98%. In another embodiment, “homology”refers to identity to any of SEQ ID NO: 1-18 of greater than 99%. Inanother embodiment, “homology” refers to identity to any of SEQ ID NO:1-18 of 100%.

The determination of percent identity between two sequences can beaccomplished using a mathematical algorithm. A non-limiting example of amathematical algorithm utilized for the comparison of two sequences isthe algorithm of Karlin and Altschul, 1990, Proc. Natl. Acad. Sci. USA87:2264-2268, modified as in Karlin and Altschul, 1993, Proc. Natl.Acad. Sci. USA90:5873-5877. Such an algorithm is incorporated into theNBLAST and XBLAST programs of Altschul et al., 1990, J. Mol. Biol.215:403-410. BLAST nucleotide searches can be performed with the NBLASTprogram, score=100, wordlength=12, to obtain nucleotide sequenceshomologous to a nucleic acid encoding a protein of interest. BLASTprotein searches can be performed with the XBLAST program, score=50,wordlength=3, to obtain amino acid sequences homologous to a protein ofinterest. To obtain gapped alignments for comparison purposes, GappedBLAST can be utilized as described in Altschul et al., 1997, NucleicAcids Res. 25:3389-3402. Alternatively, PSI-Blast can be used to performan iterated search which detects distant relationships between molecules(id.). When utilizing BLAST, Gapped BLAST, and PSI-BLAST programs, thedefault parameters of the respective programs (e.g., XBLAST and NBLAST)can be used. Another non-limiting example of a mathematical algorithmutilized for the comparison of sequences is the algorithm of Myers andMiller, CABIOS (1989). Such an algorithm is incorporated into the ALIGNprogram (version 2.0) which is part of the GCG sequence alignmentsoftware package. When utilizing the ALIGN program for comparing aminoacid sequences, a PAM120 weight residue table, a gap length penalty of12, and a gap penalty of 4 can be used. Additional algorithms forsequence analysis are known in the art and include ADVANCE and ADAM asdescribed in Torellis and Robotti, 1994, Comput. Appl. Biosci.10:3-5;and FASTA described in Pearson and Lipman, 1988, Proc. Natl. Acad. Sci.USA 85:2444-8. Within FASTA, ktup is a control option that sets thesensitivity and speed of the search. If ktup=2, similar regions in thetwo sequences being compared are found by looking at pairs of alignedresidues; if ktup=1, single aligned amino acids are examined. ktup canbe set to 2 or 1 for protein sequences, or from 1 to 6 for DNAsequences. The default if ktup is not specified is 2 for proteins and 6for DNA. Alternatively, protein sequence alignment may be carried outusing the CLUSTAL W algorithm, as described by Higgins et al., 1996,Methods Enzymol. 266:383-402.

In some embodiments, polynucleotides of the present invention areprepared using PCR techniques using procedures and methods known to oneskilled in the art. In some embodiments, the procedure involves theligation of two different DNA sequences (See, for example, “CurrentProtocols in Molecular Biology”, eds. Ausubel et al., John Wiley & Sons,1992).

In one embodiment, polynucleotides of the present invention are insertedinto expression vectors (i.e., a nucleic acid construct) to enableexpression of the recombinant polypeptide. In one embodiment, theexpression vector of the present invention includes additional sequenceswhich render this vector suitable for replication and integration inprokaryotes. In one embodiment, the expression vector of the presentinvention includes additional sequences which render this vectorsuitable for replication and integration in eukaryotes. In oneembodiment, the expression vector of the present invention includes ashuttle vector which renders this vector suitable for replication andintegration in both prokaryotes and eukaryotes. In some embodiments,cloning vectors comprise transcription and translation initiationsequences (e.g., promoters, enhancer) and transcription and translationterminators (e.g., polyadenylation signals).

In one embodiment, a variety of prokaryotic or eukaryotic cells can beused as host-expression systems to express the polypeptides of thepresent invention. In some embodiments, these include, but are notlimited to, microorganisms, such as bacteria transformed with arecombinant bacteriophage DNA, plasmid DNA or cosmid DNA expressionvector containing the polypeptide coding sequence; yeast transformedwith recombinant yeast expression vectors containing the polypeptidecoding sequence.

In some embodiments, non-bacterial expression systems are used (e.g.,mammalian expression systems such as CHO cells) to express thepolypeptide of the present invention. In one embodiment, the expressionvector used to express polynucleotides of the present invention inmammalian cells is pCI-DHFR vector comprising a CMV promoter and aneomycin resistance gene.

In some embodiments, in bacterial systems of the present invention, anumber of expression vectors can be advantageously selected dependingupon the use intended for the polypeptide expressed. In one embodiment,large quantities of polypeptide are desired. In one embodiment, vectorsthat direct the expression of high levels of the protein product,possibly as a fusion with a hydrophobic signal sequence, which directsthe expressed product into the periplasm of the bacteria or the culturemedium where the protein product is readily purified are desired. In oneembodiment, certain fusion protein engineered with a specific cleavagesite to aid in recovery of the polypeptide. In one embodiment, vectorsadaptable to such manipulation include, but are not limited to, the pETseries of E. coli expression vectors [Studier et al., Methods inEnzymol. 185:60-89 (1990)].

In one embodiment, yeast expression systems are used. In one embodiment,a number of vectors containing constitutive or inducible promoters canbe used in yeast as disclosed in U.S. Pat. No. 5,932,447. In anotherembodiment, vectors which promote integration of foreign DNA sequencesinto the yeast chromosome are used.

In one embodiment, the expression vectors of the present invention canfurther include additional polynucleotide sequences that allow, forexample, the translation of several proteins from a single mRNA such asan internal ribosome entry site (IRES) and sequences for genomicintegration of the promoter-chimeric polypeptide.

In some embodiments, the expression vectors of the present inventioninclude elements that increase the expression of the recombinant fusionproteins of the invention. Such features include, but are not limitedto, choice of promoter and polyadenylation. In some embodiments, thepolyadenylation sequence is a bovine growth hormone (BGH)polyadenylation sequence. In some embodiments, the promoter comprises aconstitutively active promoter. In some embodiments, the promotercomprises a cytomegalovirus promoter (pCMV).

In some embodiments, mammalian expression vectors include, but are notlimited to, pcDNA3, pcDNA3.1(+/−), pGL3, pZeoSV2(+/−), pSecTag2,pDisplay, pEF/myc/cyto, pCMV/myc/cyto, pCR3.1, pSinRep5, DH26S, DHBB,pNMT1, pNMT41, pNMT81, which are available from Invitrogen, pCI which isavailable from Promega, pMbac, pPbac, pBK-RSV and pBK-CMV which areavailable from Strategene, pTRES which is available from Clontech, andtheir derivatives.

In some embodiments, expression vectors containing regulatory elementsfrom eukaryotic viruses such as retroviruses are used by the presentinvention. SV40 vectors include pSVT7 and pMT2. In some embodiments,vectors derived from bovine papilloma virus include pBV-1MTHA, andvectors derived from Epstein Barr virus include pHEBO, and p205. Otherexemplary vectors include pMSG, pAV009/A⁺, pMTO10/A⁺, pMAMneo-5,baculovirus pDSVE, and any other vector allowing expression of proteinsunder the direction of the SV-40 early promoter, SV-40 later promoter,metallothionein promoter, murine mammary tumor virus promoter, Roussarcoma virus promoter, polyhedrin promoter, or other promoters showneffective for expression in eukaryotic cells.

In some embodiments, recombinant viral vectors are useful for in vivoexpression of the polypeptides of the present invention since they offeradvantages such as lateral infection and targeting specificity. In oneembodiment, lateral infection is inherent in the life cycle of, forexample, retrovirus and is the process by which a single infected cellproduces many progeny virions that bud off and infect neighboring cells.In one embodiment, the result is that a large area becomes rapidlyinfected, most of which was not initially infected by the original viralparticles. In one embodiment, viral vectors are produced that are unableto spread laterally. In one embodiment, this characteristic can beuseful if the desired purpose is to introduce a specified gene into onlya localized number of targeted cells.

In one embodiment, various methods can be used to introduce theexpression vector encoding the recombinant fusion protein of the presentinvention into cells. Such methods are generally described in Sambrooket al., Molecular Cloning: A Laboratory Manual, Cold Springs HarborLaboratory, New York (1989, 1992), in Ausubel et al., Current Protocolsin Molecular Biology, John Wiley and Sons, Baltimore, Md. (1989), Changet al., Somatic Gene Therapy, CRC Press, Ann Arbor, Mich. (1995), Vegaet al., Gene Targeting, CRC Press, Ann Arbor Mich. (1995), Vectors: ASurvey of Molecular Cloning Vectors and Their Uses, Butterworths, BostonMass. (1988) and Gilboa et at. [Biotechniques 4 (6): 504-512, 1986] andinclude, for example, stable or transient transfection, lipofection,electroporation and infection with recombinant viral vectors. Inaddition, see U.S. Pat. Nos. 5,464,764 and 5,487,992 forpositive-negative selection methods.

In some embodiments, introduction of nucleic acid by viral infectionoffers several advantages over other methods such as lipofection andelectroporation, since higher transfection efficiency can be obtaineddue to the infectious nature of viruses.

In one embodiment, it will be appreciated that the polypeptides of thepresent invention can also be expressed from a nucleic acid constructadministered to the individual employing any suitable mode ofadministration, described hereinabove (i.e., in-vivo gene therapy). Inone embodiment, the nucleic acid construct is introduced into a suitablecell via an appropriate gene delivery vehicle/method (transfection,transduction, homologous recombination, etc.) and an expression systemas needed and then the modified cells are expanded in culture andreturned to the individual (i.e., ex-vivo gene therapy).

It will be appreciated that other than containing the necessary elementsfor the transcription and translation of the inserted coding sequence(encoding the polypeptide), the expression construct of the presentinvention can also include sequences engineered to optimize stability,production, purification, yield or activity of the expressedpolypeptide.

In some embodiments, transformed cells are cultured under effectiveconditions, which allow for the expression of high amounts ofrecombinant fusion protein or polypeptide. In some embodiments,effective culture conditions include, but are not limited to, effectivemedia, bioreactor, temperature, pH and oxygen conditions that permitprotein production. In one embodiment, an effective medium refers to anymedium in which a cell is cultured to produce the recombinantpolypeptide of the present invention. In some embodiments, a mediumtypically includes an aqueous solution having assimilable carbon,nitrogen and phosphate sources, and appropriate salts, minerals, metalsand other nutrients, such as vitamins. In some embodiments, cells of thepresent invention can be cultured in conventional fermentationbioreactors, shake flasks, test tubes, microtiter dishes and petriplates. In some embodiments, culturing is carried out at a temperature,pH and oxygen content appropriate for a recombinant cell. In someembodiments, culturing conditions are within the expertise of one ofordinary skill in the art.

In some embodiments, depending on the vector and host system used forproduction, resultant polypeptides of the present invention eitherremain within the recombinant cell, secreted into the fermentationmedium, secreted into a space between two cellular membranes, such asthe periplasmic space in E. coli; or retained on the outer surface of acell or viral membrane.

In one embodiment, following a predetermined time in culture, recoveryof the recombinant polypeptide is effected.

In one embodiment, the phrase “recovering the recombinant polypeptide”used herein refers to collecting the whole fermentation mediumcontaining the polypeptide and need not imply additional steps ofseparation or purification.

In one embodiment, polypeptides of the present invention are purifiedusing a variety of standard protein purification techniques, such as,but not limited to, affinity chromatography, ion exchangechromatography, filtration, electrophoresis, hydrophobic interactionchromatography, gel filtration chromatography, reverse phasechromatography, concanavalin A chromatography, chromatofocusing anddifferential solubilization.

In one embodiment, to facilitate recovery, the expressed coding sequencecan be engineered to encode the polypeptide of the present invention andfused cleavable moiety. In one embodiment, a fusion protein can bedesigned so that the polypeptide can be readily isolated by affinitychromatography; e.g., by immobilization on a column specific for thecleavable moiety. In one embodiment, a cleavage site is engineeredbetween the polypeptide and the cleavable moiety and the polypeptide canbe released from the chromatographic column by treatment with anappropriate enzyme or agent that specifically cleaves the fusion proteinat this site [e.g., see Booth et al., Immunol. Lett. 19:65-70 (1988);and Gardella et al., J. Biol. Chem. 265:15854-15859 (1990)].

In one embodiment, the polypeptide of the present invention is retrievedin “substantially pure” form.

In one embodiment, the phrase “substantially pure” refers to a puritythat allows for the effective use of the protein in the applicationsdescribed herein.

In one embodiment, the polypeptide of the present invention can also besynthesized using in vitro expression systems. In one embodiment, invitro synthesis methods are well known in the art and the components ofthe system are commercially available.

In some embodiments, the recombinant polypeptides are synthesized andpurified; their therapeutic efficacy can be assayed in vivo or in vitro.

In one embodiment, the pharmaceutical composition provided hereincomprising the recombinant fusion protein of the invention is furtherformulated with a pharmaceutical carrier. As used herein,“pharmaceutical carrier” includes any and all solvents, dispersionmedia, coatings, antibacterial and antifungal agents, isotonic andabsorption delaying agents, and the like that are physiologicallycompatible. Preferably, the carrier is suitable for intravenous,intramuscular, subcutaneous, parenteral, spinal or epidermaladministration (e.g. by injection or infusion).

Therapeutic Methods

In one embodiment, the present invention provides a method of treating adisease or condition in a subject in need thereof, the method comprisingadministering a therapeutically effective amount of the recombinantfusion protein or the pharmaceutical composition comprising therecombinant fusion protein disclosed herein.

In one embodiment, the present invention provides a method of treating acardiovascular disease or condition in a subject in need thereof, themethod comprising administering a therapeutically effective amount ofthe recombinant fusion protein or a pharmaceutical compositioncomprising the same.

In one embodiment, the present invention provides a method ofpreventing, inhibiting, suppressing or delaying the onset of acardiovascular disease or condition in a subject, the method comprisingadministering an effective amount of the recombinant fusion protein orthe pharmaceutical composition described herein.

In some embodiments, the cardiovascular disease comprises a chronicheart failure/Congestive heart failure (CHF), acute heartfailure/myocardial infarction (MI), left ventricular systolicdysfunction, reperfusion injury associated with MI, chemotherapy-inducedcardiotoxicity (adult or pediatric), radiation-induced cardiotoxicity,adjunct to surgical intervention in pediatric congenital heart disease.

In some embodiments, the wherein the chemotherapy-induced cardiotoxicityresults from a subject receiving anthracyclines, alkylating agents,antimicrotubule agents, and antimetabolites agents used as chemotherapy.

In some embodiments, the cardiovascular condition is cardiotoxicity as aresult of a subject receiving a cancer therapy. In other embodiments,the cancer therapy is a HER-2 targeted therapy. In other embodiments,the HER-2 targeted therapy comprises use of trastuzumab,ado-trastuzumab, emtansine, lapatinib, neratinib, and pertuzumab, anyanti-HER2 antibody, any anti-HER2 agent or a combination thereof.

In another aspect, the invention relates to a method of inducingremodeling of muscle cell sarcomeric and cytoskeleton structures, orcell-cell adhesions, the method comprising treating the cells with therecombinant fusion protein disclosed herein.

In one embodiment, the therapeutic method is directed to treating heartfailure resulting from disassociation of cardiac muscle cell-celladhesion and/or the disarray of sarcomeric structures in the mammal.

In another aspect, the present invention provides a method forpreventing, treating or delaying heart failure with preserved ejectionfraction in a human, the method comprising administering apharmaceutical composition comprising a recombinant fusion proteindisclosed herein.

As used herein, the term “ejection fraction” refers to Ejection fraction(EF), a measurement, typically expressed as a percentage, of how muchblood the left ventricle pumps out with each contraction. For example,an ejection fraction of 50 percent means that 50 percent of the totalamount of blood in the left ventricle is pushed out with each heartbeat.

The invention is directed to treating subjects with or at risk fordevelopment of heart disease and related conditions, e.g., heartfailure.

By the term “heart failure” is meant an abnormality of cardiac functionwhere the heart does not pump blood at the rate needed for therequirements of metabolizing tissues. Heart failure includes a widerange of disease states such as congestive heart failure, myocardialinfarction, tachyarrhythmia, familial hypertrophic cardiomyopathy,ischaemic heart disease, idiopathic dilated cardiomyopathy, andmyocarditis. The heart failure can be caused by any number of factors,including ischaemic, congenital, rheumatic, or idiopathic forms. Chroniccardiac hypertrophy is a significantly diseased state which is aprecursor to congestive heart failure and cardiac arrest.

In one embodiment, “treatment” refers to both therapeutic treatment andprophylactic or preventative measures, wherein the object is to preventor slow down (lessen) heart hypertrophy. Those in need of treatmentinclude those already with the disorder as well as those prone to havethe disorder or those in which the disorder is to be prevented. Theheart hypertrophy may be from any cause which is responsive to retinoicacid, including congenital, viral, idiopathic, cardiotrophic, ormyotrophic causes, or as a result of ischaemia or ischaemic insults suchas myocardial infarction. Typically, the treatment is performed to stopor slow the progression of hypertrophy, especially after heart damage,such as from ischaemia, has occurred. Preferably, for treatment ofmyocardial infarctions, the pharmaceutical composition provided hereinis given immediately after the myocardial infarction, to prevent orlessen hypertrophy.

In some embodiments, treating a subject with a pharmaceuticalcomposition comprising the recombinant fusion protein provided hereincan result in increase in average survival time of a population oftreated subjects in comparison to a population receiving monotherapywith a drug that is not a compound of the disclosure, or apharmaceutically acceptable salt, solvate, analog or derivative thereof.Preferably, after treatment with the strategies, treatment modalities,methods, combinations, and compositions provided herein, the averagesurvival time is increased by more than 30 days; more preferably, bymore than 60 days; more preferably, by more than 90, 120, or 365 days;more preferably, by more than 365 days. An increase in average survivaltime of a population may be measured by any reproducible means. Anincrease in average survival time of a population may be measured, forexample, by calculating for a population the average length of survivalfollowing initiation of treatment with an active compound. An increasein average survival time of a population may also be measured, forexample, by calculating for a population the average length of survivalfollowing completion of a first round of treatment with thepharmaceutical composition disclosed herein.

In some embodiments, treating a subject with a pharmaceuticalcomposition comprising the recombinant fusion protein provided hereincan result in a decrease in the mortality rate of a population oftreated subjects in comparison to a population receiving carrier alone.Treating cancer can result in a decrease in the mortality rate of apopulation of treated subjects in comparison to an untreated population.Treating cancer can result in a decrease in the mortality rate of apopulation of treated subjects in comparison to a population receivingmonotherapy with a drug that is not a compound of the disclosure, or apharmaceutically acceptable salt, solvate, analog or derivative thereof.Preferably, after treatment with the strategies, treatment modalities,methods, combinations, and compositions provided herein, the mortalityrate is decreased by more than 2%; more preferably, by more than 5%;more preferably, by more than 10%; and most preferably, by more than25%. A decrease in the mortality rate of a population of treatedsubjects may be measured by any reproducible means. A decrease in themortality rate of a population may be measured, for example, bycalculating for a population the average number of disease-relateddeaths per unit time following initiation of treatment with an activecompound. A decrease in the mortality rate of a population may also bemeasured, for example, by calculating for a population the averagenumber of disease-related deaths per unit time following completion of afirst round of treatment with the pharmaceutical composition disclosedherein.

In one embodiment, the present invention provides a method of treating acentral nervous system (CNS)-related disease or condition in a subjectin need thereof, the method comprising administering a therapeuticallyeffective amount of the recombinant fusion protein or the pharmaceuticalcomposition described herein.

In one embodiment, the present invention provides a method ofpreventing, inhibiting, suppressing or delaying the onset of aCNS-related disease or condition in a subject, the method comprisingadministering an effective amount of the recombinant fusion protein orthe pharmaceutical composition described herein.

In some embodiments, the CNS-related disease or condition is amyotrophiclateral sclerosis (ALS), Parkinson's disease, Alzheimer's Disease,Bell's Palsy, epilepsy and seizures, Guillain-Barre Syndrome, stroke,traumatic brain injury, multiple sclerosis or a combination.

Administration, Dosing

A composition of the present invention can be parenterally administeredto a subject in need thereof, or can be administered by a variety ofmethods known in the art. As will be appreciated by the skilled artisan,the route and/or mode of administration will vary depending upon thedesired results. To administer a compound of the invention by certainroutes of administration, it may be necessary to coat the compound with,or co-administer the compound with, a material to prevent itsinactivation. For example, the compound may be administered to a subjectin an appropriate carrier, for example, liposomes, or a diluent.Pharmaceutically acceptable diluents include saline and aqueous buffersolutions. Pharmaceutical carriers include sterile aqueous solutions ordispersions and sterile powders for the extemporaneous preparation ofsterile injectable solutions or dispersion. The use of such media andagents for pharmaceutically active substances is known in the art.

In typical embodiments, preparations for administration to subjectsinclude sterile aqueous or non-aqueous solutions, suspensions, andemulsions. Some embodiments include non-aqueous solvents such aspropylene glycol, polyethylene glycol, vegetable oils (e.g., oliveoils), organic esters (e.g., ethyl oleate) and other solvents known tothose of skill in the art. Physiologically acceptable carriers (orexcipients) are optionally used in certain embodiments of the invention.Examples of such include, e.g., saline, PBS, Ringer's solution, lactatedRinger's solution, etc. Additionally, preservatives and additives areoptionally added to the compositions to help ensure stability andsterility. For example, antibiotics and other bacteriocides,antioxidants, chelating agents, and the like are all optionally presentin various embodiments of the compositions herein.

The phrases “parenteral administration” and “administered parenterally”as used herein means modes of administration other than enteral andtopical administration, usually by injection, and includes, withoutlimitation, intravenous, intramuscular, intra-arterial, intrathecal,intracapsular, intraorbital, intracardiac, intradermal, intraperitoneal,transtracheal, subcutaneous, subcuticular, intra-articular, subcapsular,subarachnoid, intraspinal, epidural and intrasternal injection andinfusion.

Regardless of the route of administration selected, the compounds of thepresent invention, which may be used in a suitable hydrated form, and/orthe pharmaceutical compositions of the present invention, are formulatedinto pharmaceutically acceptable dosage forms by conventional methodsknown to those of skill in the art.

The recombinant fusion protein, or pharmaceutical composition comprisingthe same are optionally administered to subjects in need of treatment(either therapeutically or prophylactically) in any appropriate sterilepharmaceutical carrier. Such pharmaceutical carrier acts to maintain thesolubility and action of the fusion protein. In some embodiments, it maybe desired to administer additional components in conjunction with thefusion protein. For example, in some treatment regimes, chemotherapeuticagents, antibiotics, additional formulations comprising the recombinantfusion protein of the invention and one or more standard of care agents,etc. are all optionally included with the compositions of the invention.

As used herein, the terms “combination treatment,” “combinationtherapy,” and “co-therapy” are used interchangeably and generally referto treatment modalities featuring an recombinant fusion protein orpharmaceutical composition comprising the same as provided herein and anadditional therapeutic agent. Typically, combination treatmentmodalities are part of a specific treatment regimen intended to providea beneficial effect from the concurrent action of the therapeutic agentcombination. The beneficial effect of the combination may include, butis not limited to, pharmacokinetic or pharmacodynamic co-actionresulting from the combination of therapeutic agents. Administration ofthese therapeutic agents in combination typically is carried out over adefined time period (usually minutes, hours, days or weeks dependingupon the combination selected). In some embodiments, combinationtreatment comprises administration of two or more therapeutic agents ina sequential manner, wherein each therapeutic agent is administered at adifferent time, as well as administration of these therapeutic agents,or at least two of the therapeutic agents, in a substantiallysimultaneous manner. Substantially simultaneous administration can beaccomplished, for example, by administering to the subject a singledosage form having a fixed ratio of each therapeutic agent or inmultiple, separate dosage forms for the therapeutic agents. Sequentialor substantially simultaneous administration of each therapeutic agentcan be effected by any appropriate route including, but not limited to,oral routes, intravenous routes, intramuscular routes, and directabsorption through mucous membrane tissues. The therapeutic agents canbe administered by the same route or by different routes. Thetherapeutic agents can be administered according to the same or to adifferent administration interval. For example, a first therapeuticagent of the combination selected may be administered by intravenousinjection while the other therapeutic agents of the combination may beadministered orally. Alternatively, for example, all therapeutic agentsmay be administered orally or all therapeutic agents may be administeredby intravenous injection.

In some embodiments, combination therapy also embraces theadministration of the therapeutic agents as described above in furthercombination with other biologically active ingredients and non-drugtherapies (e.g., surgery or radiation treatment). Where the combinationtherapy further comprises a non-drug treatment, the non-drug treatmentmay be conducted at any suitable time so long as a beneficial effectfrom the co-action of the combination of the therapeutic agents andnon-drug treatment is achieved. For example, in appropriate cases, thebeneficial effect is still achieved when the non-drug treatment istemporally removed from the administration of the therapeutic agents,perhaps by days or even weeks.

In some embodiments, the additional therapeutic agent is achemotherapeutic agent (also referred to as an anti-neoplastic agent oranti-proliferative agent), e.g., an alkylating agent; an antibiotic; ananti-metabolite; a detoxifying agent; an interferon; a polyclonal ormonoclonal antibody; an EGFR inhibitor; a HER2 inhibitor; a histonedeacetylase inhibitor; a hormone; a mitotic inhibitor; an MTORinhibitor; a multi-kinase inhibitor; a serine/threonine kinaseinhibitor; a tyrosine kinase inhibitors; a VEGF/VEGFR inhibitor; ataxane or taxane derivative, an aromatase inhibitor, an anthracycline, amicrotubule targeting drug, a topoisomerase poison drug, an inhibitor ofa molecular target or enzyme (e.g., a kinase or a proteinmethyltransferase), a cytidine analogue drug or any chemotherapeutic, animmune checkpoint inhibitor, a platinum based antineoplastic agent, aCDK inhibitor, a PARP inhibitor or any anti-neoplastic oranti-proliferative agent known to those of skill in the art.

Exemplary alkylating agents suitable for use according to thecombination treatment modalities provided herein include, but are notlimited to, cyclophosphamide (Cytoxan; Neosar); chlorambucil (Leukeran);melphalan (Alkeran); carmustine (BiCNU); busulfan (Busulfex); lomustine(CeeNU); dacarbazine (DTIC-Dome); oxaliplatin (Eloxatin); carmustine(Gliadel); ifosfamide (Ifex); mechlorethamine (Mustargen); busulfan(Myleran); carboplatin (Paraplatin); cisplatin (CDDP; Platinol);temozolomide (Temodar); thiotepa (Thioplex); bendamustine (Treanda); orstreptozocin (Zanosar).

Exemplary suitable anthracyclines include, but are not limited to,doxorubicin (Adriamycin); doxorubicin liposomal (Doxil); mitoxantrone(Novantrone); bleomycin (Blenoxane); daunorubicin (Cerubidine);daunorubicin liposomal (DaunoXome); dactinomycin (Cosmegen); epirubicin(Ellence); idarubicin (Idamycin); plicamycin (Mithracin); mitomycin(Mutamycin); pentostatin (Nipent); or valrubicin (Valstar).

Exemplary anti-metabolites include, but are not limited to, fluorouracil(Adrucil); capecitabine (Xeloda); hydroxyurea (Hydrea); mercaptopurine(Purinethol); pemetrexed (Alimta); fludarabine (Fludara); nelarabine(Arranon); cladribine (Cladribine Novaplus); clofarabine (Clolar);cytarabine (Cytosar-U); decitabine (Dacogen); cytarabine liposomal(DepoCyt); hydroxyurea (Droxia); pralatrexate (Folotyn); floxuridine(FUDR); gemcitabine (Gemzar); cladribine (Leustatin); fludarabine(Oforta); methotrexate (MTX; Rheumatrex); methotrexate (Trexall);thioguanine (Tabloid); TS-1 or cytarabine (Tarabine PFS).

Exemplary detoxifying agents include, but are not limited to, amifostine(Ethyol) or mesna (Mesnex).

Exemplary interferons include, but are not limited to, interferonalfa-2b (Intron A) or interferon alfa-2a (Roferon-A).

Exemplary polyclonal or monoclonal antibodies include, but are notlimited to, trastuzumab (Herceptin); ofatumumab (Arzerra); bevacizumab(Avastin); rituximab (Rittman); cetuximab (Erbitux); panitumumab(Vectibix); tositumomab/iodine-131 tositumomab (Bexxar); alemtuzumab(Campath); ibritumomab (Zevalin; In-111; Y-90 Zevalin); gemtuzumab(Mylotarg); eculizumab (Soliris) or denosumab.

Exemplary EGFR inhibitors include, but are not limited to, gefitinib(Iressa); lapatinib (Tykerb); cetuximab (Erbitux); erlotinib (Tarceva);panitumumab (Vectibix); PKI-166; canertinib (CI-1033); matuzumab (EMD72000) or EKB-569.

Exemplary HER2 inhibitors include, but are not limited to, trastuzumab(Herceptin); lapatinib (Tykerb) or AC-480.

Histone Deacetylase Inhibitors include, but are not limited to,vorinostat (Zolinza).

Exemplary hormones include, but are not limited to, tamoxifen (Soltamox;Nolvadex); raloxifene (Evista); megestrol (Megace); leuprolide (Lupron;Lupron Depot; Eligard; Viadur); fulvestrant (Faslodex); letrozole(Femara); triptorelin (Trelstar LA; Trelstar Depot); exemestane(Aromasin); goserelin (Zoladex); bicalutamide (Casodex); anastrozole(Arimidex); fluoxymesterone (Androxy; Halotestin); medroxyprogesterone(Provera; Depo-Provera); estramustine (Emcyt); flutamide (Eulexin);toremifene (Fareston); degarelix (Firmagon); nilutamide (Nilandron);abarelix (Plenaxis); or testolactone (Teslac).

Exemplary mitotic inhibitors include, but are not limited to, paclitaxel(Taxol; Onxol; Abraxane); docetaxel (Taxotere); vincristine (Oncovin;Vincasar PFS); vinblastine (Velban); etoposide (Toposar; Etopophos;VePesid); teniposide (Vumon); ixabepilone (Ixempra); nocodazole;epothilone; vinorelbine (Navelbine); camptothecin (CPT); irinotecan(Camptosar); topotecan (Hycamtin); amsacrine or lamellarin D (LAM-D).

Exemplary MTOR inhibitors include, but are not limited to, everolimus(Afinitor) or temsirolimus (Torisel); rapamune, ridaforolimus; orAP23573.

Exemplary multi-kinase inhibitors include, but are not limited to,sorafenib (Nexavar); sunitinib (Sutent); BIBW 2992; E7080; Zd6474;PKC-412; motesanib; or AP24534.

Exemplary serine/threonine kinase inhibitors include, but are notlimited to, ruboxistaurin; eril/fasudil hydrochloride; flavopiridol;seliciclib (CYC202; Roscovitine); SNS-032 (BMS-387032); Pkc412;bryostatin; KAI-9803; SF1126; VX-680; Azd1152; Arry-142886 (AZD-6244);SCIO-469; GW681323; CC-401; CEP-1347 or PD 332991.

Exemplary tyrosine kinase inhibitors include, but are not limited to,erlotinib (Tarceva); gefitinib (Iressa); imatinib (Gleevec); sorafenib(Nexavar); sunitinib (Sutent); trastuzumab (Herceptin); bevacizumab(Avastin); rituximab (Rittman); lapatinib (Tykerb); cetuximab (Erbitux);panitumumab (Vectibix); everolimus (Afinitor); alemtuzumab (Campath);gemtuzumab (Mylotarg); temsirolimus (Torisel); pazopanib (Votrient);dasatinib (Sprycel); nilotinib (Tasigna); vatalanib (Ptk787; ZK222584);CEP-701; SU5614; MLN518; XL999; VX-322; Azd0530; BMS-354825; SKI-606CP-690; AG-490; WHI-P154; WHI-P131; AC-220; or AMG888.

Exemplary VEGF/VEGFR inhibitors include, but are not limited to,bevacizumab (Avastin), sorafenib (Nexavar), sunitinib (Sutent),ranibizumab, pegaptanib, or vandetinib.

Exemplary microtubule targeting drugs include, but are not limited to,paclitaxel, docetaxel, vincristin, vinblastin, nocodazole, epothilonesand navelbine.

Exemplary topoisomerase poison drugs include, but are not limited to,teniposide, etoposide, adriamycin, camptothecin, daunorubicin,dactinomycin, mitoxantrone, amsacrine, epirubicin and idarubicin.

Exemplary taxanes or taxane derivatives include, but are not limited to,paclitaxel and docetaxol.

Exemplary immune checkpoint inhibitors include programmed cell death 1(PD-1), CD274 molecule (PD-L1) and cytotoxic T-lymphocyte associatedprotein 4 (CTLA4) inhibitors. Exemplary PD-1 inhibitors includePembrolizumab, Nivolumab and Cemiplimab. Exemplary PD-L1 inhibitorsinclude Atezolizumab, Avelumab and Durvalumab. Exemplary CLTA4inhibitors include Ipilimumab.

Exemplary platinum based antineoplastic agents include Cisplatin andCarboplatin.

Exemplary cyclin dependent kinase (CDK) inhibitors include abemaciclib,palbociclib, and ribociclib.

Exemplary poly (ADP-ribose) polymerase (PARP) inhibitors includetalazoparib, olaparib, rucaparib, niraparib and veliparib.

Exemplary general chemotherapeutic, anti-neoplastic, anti-proliferativeagents include, but are not limited to, altretamine (Hexalen);isotretinoin (Accutane; Amnesteem; Claravis; Sotret); tretinoin(Vesanoid); azacitidine (Vidaza); bortezomib (Velcade) asparaginase(Elspar); levamisole (Ergamisol); mitotane (Lysodren); procarbazine(Matulane); pegaspargase (Oncaspar); denileukin diftitox (Ontak);porfimer (Photofrin); aldesleukin (Proleukin); lenalidomide (Revlimid);bexarotene (Targretin); thalidomide (Thalomid); temsirolimus (Torisel);arsenic trioxide (Trisenox); verteporfin (Visudyne); mimosine(Leucenol); (1M tegafur—0.4 M 5-chloro-2,4-dihydroxypyrimidine—1 Mpotassium oxonate) or lovastatin.

In some embodiments, combination treatment modalities are provided inwhich the additional therapeutic agent is a cytokine, e.g., G-CSF(granulocyte colony stimulating factor). In another aspect, apharmaceutical composition provided herein may be administered incombination with radiation therapy. Radiation therapy can also beadministered in combination with a pharmaceutical composition providedherein and another chemotherapeutic agent described herein as part of amulti-agent therapy. In yet another aspect, a pharmaceutical compositionprovided herein may be administered in combination with standardchemotherapy combinations such as, but not restricted to, CMF(cyclophosphamide, methotrexate and 5-fluorouracil), CAF(cyclophosphamide, adriamycin and 5-fluorouracil), AC (adriamycin andcyclophosphamide), FEC (5-fluorouracil, epirubicin, andcyclophosphamide), ACT or ATC (adriamycin, cyclophosphamide, andpaclitaxel), rituximab, Xeloda (capecitabine), Cisplatin (CDDP),Carboplatin, TS-1 (tegafur, gimestat and otastat potassium at a molarratio of 1:0.4:1), Camptothecin-11 (CPT-11, Irinotecan or Camptosar™),CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone orprednisolone), R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin,oncovin, prednisone or prednisolone), or CMFP (cyclophosphamide,methotrexate, 5-fluorouracil and prednisone).

In some preferred embodiments, a pharmaceutical composition providedherein may be administered with an inhibitor of an enzyme, such as areceptor or non-receptor kinase. Receptor and non-receptor kinases are,for example, tyrosine kinases or serine/threonine kinases. Kinaseinhibitors described herein are small molecules, polynucleic acids,polypeptides, or antibodies.

Exemplary kinase inhibitors include, but are not limited to, Bevacizumab(targets VEGF), BIBW 2992 (targets EGFR and Erb2), Cetuximab/Erbitux(targets Erbl), Imatinib/Gleevec (targets Bcr-Abl), Trastuzumab (targetsErb2), Gefitinib/Iressa (targets EGFR), Ranibizumab (targets VEGF),Pegaptanib (targets VEGF), Erlotinib/Tarceva (targets Erb1), Nilotinib(targets Bcr-Abl), Lapatinib (targets Erb1 and Erb2/Her2),GW-572016/1apatinib ditosylate (targets HER2/Erb2), Panitumumab/Vectibix(targets EGFR), Vandetinib (targets RET/VEGFR), E7080 (multiple targetsincluding RET and VEGFR), Herceptin (targets HER2/Erb2), PKI-166(targets EGFR), Canertinib/CI-1033 (targets EGFR),Sunitinib/SU-11464/Sutent (targets EGFR and FLT3), Matuzumab/Emd7200(targets EGFR), EKB-569 (targets EGFR), Zd6474 (targets EGFR and VEGFR),PKC-412 (targets VEGR and FLT3), Vatalanib/Ptk787/ZK222584 (targetsVEGR), CEP-701 (targets FLT3), SU5614 (targets FLT3), MLN518 (targetsFLT3), XL999 (targets FLT3), VX-322 (targets FLT3), Azd0530 (targetsSRC), BMS-354825 (targets SRC), SKI-606 (targets SRC), CP-690 (targetsJAK), AG-490 (targets JAK), WHI-P154 (targets JAK), WHI-P131 (targetsJAK), sorafenib/Nexavar (targets RAF kinase, VEGFR-1, VEGFR-2, VEGFR-3,PDGFR-B, KIT, FLT-3, and RET), Dasatinib/Sprycel (BCR/ABL and Src),AC-220 (targets Flt3), AC-480 (targets all HER proteins, “panHER”),Motesanib diphosphate (targets VEGF1-3, PDGFR, and c-kit), Denosumab(targets RANKL, inhibits SRC), AMG888 (targets HER3), and AP24534(multiple targets including Flt3).

In another embodiment, the recombinant fusion protein or pharmaceuticalcomposition comprising the same polypeptide disclosed herein isadministered to a subject once a day. In some embodiments, therecombinant fusion protein or pharmaceutical composition comprising thesame is administered to a subject once every two days. In anotherembodiment, the recombinant fusion protein or pharmaceutical compositioncomprising the same is administered to a subject once every three days.In another embodiment, the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject once everyfour days. In another embodiment, the recombinant fusion protein orpharmaceutical composition comprising the same is administered to asubject once every five days. In another embodiment, the recombinantfusion protein or pharmaceutical composition comprising the samepolypeptide is administered to a subject once every six days. In anotherembodiment, the recombinant fusion protein or pharmaceutical compositioncomprising the same is administered to a subject once every week. Inanother embodiment, the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject once every7-14 days. In another embodiment, the recombinant fusion protein orpharmaceutical composition comprising the same is administered to asubject once every 10-20 days. In another embodiment, the recombinantfusion protein or pharmaceutical composition comprising the same isadministered to a subject once every 5-15 days. In another embodiment,the recombinant fusion protein or pharmaceutical composition comprisingthe same is administered to a subject once every 15-30 days.

In one embodiment, a dose of the recombinant fusion protein of thepresent invention comprises from 0.005 to 0.1 milligrams/kg in aninjectable solution. In another embodiment, the dose comprises from0.005 to 0.5 milligrams/kg of the recombinant fusion protein. In anotherembodiment, the dose comprises from 0.05 to 0.1 micrograms of therecombinant fusion protein. In another embodiment, the dose comprisesfrom 0.005 to 0.1 milligrams/kg of the recombinant fusion protein in aninjectable solution.

In another embodiment, the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject in a doseranging from 0.0001 mg to 0.6 mg. In another embodiment, the recombinantfusion protein or pharmaceutical composition comprising the same isadministered to a subject in a dose ranging from 0.001 mg to 0.005 mg.In another embodiment, the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject in a doseranging from 0.005 mg to 0.01 mg. In another embodiment, the recombinantfusion protein or pharmaceutical composition comprising the same isadministered to a subject in a dose ranging from 0.01 mg to 0.3 mg. Inanother embodiment, the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject in a doseranging from 0.2 mg to 0.6 mg.

In another embodiment, the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject in a doseranging from 1-100 mcg/kg. In another embodiment, the recombinant fusionprotein or pharmaceutical composition comprising the same isadministered to a subject in a dose ranging from 10-80 mcg/kg. Inanother embodiment, the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject in a doseranging from 20-60 mcg/kg. In another embodiment, the recombinant fusionprotein or pharmaceutical composition comprising the same isadministered to a subject in a dose ranging from 10-50 mcg/kg. Inanother embodiment, the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject in a doseranging from 40-80 mcg/kg. In another embodiment, the recombinant fusionprotein or pharmaceutical composition comprising the same isadministered to a subject in a dose ranging from 10-30 mcg/kg. Inanother embodiment, the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject in a doseranging from 30-60 mcg/kg.

In another embodiment, the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject in a doseranging from 0.1 mcg/kg to 100 mg/kg. In another embodiment, therecombinant fusion protein or pharmaceutical composition comprising thesame is administered to a subject in a dose ranging from 0.1 mcg/kg to50 mg/kg. In another embodiment, the recombinant fusion protein orpharmaceutical composition comprising the same is administered to asubject in a dose ranging from 0.1 mcg/kg to 25 mg/kg. In anotherembodiment, the recombinant fusion protein or pharmaceutical compositioncomprising the same is administered to a subject in a dose ranging from0.1 mcg/kg to 10 mg/kg. In another embodiment, the recombinant fusionprotein or pharmaceutical composition comprising the same isadministered to a subject in a dose ranging from 0.1 mcg/kg to 5 mg/kg.In another embodiment, the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject in a doseranging from 0.1 mcg/kg to 1 mg/kg. In another embodiment, therecombinant fusion protein or pharmaceutical composition comprising thesame is administered to a subject in a dose ranging from 0.1 mcg/kg to0.1 mg/kg. In another embodiment, the recombinant fusion protein orpharmaceutical composition comprising the same is administered to asubject in a dose ranging from 10 mg/kg to 60 mg/kg.

In another embodiment, the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject in a doseof about 0.5 mg/kg, about 1 mg/kg, about 2 mg/kg, about 3 mg/kg, about 4mg/kg, about 5 mg/kg, about 6 mg/kg, about 7 mg/kg, about 8 mg/kg, about9 mg/kg, about 10 mg/kg, about 20 mg/kg, about 30 mg/kg, about 40 mg/kg,about 50 mg/kg, about 60 mg/kg or about 70 mg/kg.

In another embodiment, the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject in a doseranging from 0.2 mg to 2 mg. In another embodiment, the recombinantfusion protein or pharmaceutical composition comprising the same isadministered to a subject in a dose ranging from 2 mg to 6 mg. Inanother embodiment, the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject in a doseranging from 4 mg to 10 mg. In another embodiment, the recombinantfusion protein or pharmaceutical composition comprising the same isadministered to a subject in a dose ranging from 5 mg and 15 mg.

In one embodiment, a recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject in a doseranging from 10 μg/kg-1000 μg/kg. In another embodiment, a recombinantfusion protein or pharmaceutical composition comprising the same isadministered to a subject in a dose ranging from 25 μg/kg-600 μg/kg. Inanother embodiment, a recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject in a doseranging from 50 μg/kg-400 μg/kg. In another embodiment, a recombinantfusion protein or pharmaceutical composition comprising the same isadministered to a subject in a dose of about 25 μg/kg. In anotherembodiment, a recombinant fusion protein or pharmaceutical compositioncomprising the same is administered to a subject in a dose of about 50μg/kg. In another embodiment, a recombinant fusion protein orpharmaceutical composition comprising the same is administered to asubject in a dose of about 100 μg/kg. In another embodiment, arecombinant fusion protein or pharmaceutical composition comprising thesame is administered to a subject in a dose of about 200 μg/kg. Inanother embodiment, a recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject in a doseof about 300 μg/kg. In another embodiment, a recombinant fusion proteinor pharmaceutical composition comprising the same is administered to asubject in a dose of about 400 μg/kg. In another embodiment, arecombinant fusion protein or pharmaceutical composition comprising thesame is administered to a subject in a dose of about 500 μg/kg. Inanother embodiment, a recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject in a doseof about 600 μg/kg.

In one embodiment, a single one time dose of the recombinant fusionprotein or pharmaceutical composition comprising the same isadministered to a subject. In another embodiment, a total of two dosesare administered to the subject. In another embodiment, a total of twoor more doses are administered to the subject.

In another embodiment, a dose of the recombinant fusion protein orpharmaceutical composition comprising the same is administered to asubject at least once a day. In another embodiment, a dose of therecombinant fusion protein or pharmaceutical composition comprising thesame is administered to a subject at least once every two days. Inanother embodiment, a dose of the recombinant fusion protein orpharmaceutical composition comprising the same is administered to asubject at least once a every two or more days. In another embodiment, adose of the recombinant fusion protein or pharmaceutical compositioncomprising the same is administered to a subject every week, biweekly orevery three weeks. In another embodiment, a dose of the recombinantfusion protein or pharmaceutical composition comprising the same isadministered to a subject at least once a week. In another embodiment, adose of the recombinant fusion protein or pharmaceutical compositioncomprising the same is administered to a subject at least once every twoweeks. In another embodiment, a dose of the recombinant fusion proteinor pharmaceutical composition comprising the same is administered to asubject at least once every three weeks. In another embodiment, a doseof the recombinant fusion protein or pharmaceutical compositioncomprising the same is administered to a subject at least once everythree or more weeks. In another embodiment, a dose of the recombinantfusion protein or pharmaceutical composition comprising the same isadministered to a subject two or more times a week. In anotherembodiment, a dose of the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject two or moretimes a month. In another embodiment, a dose of the recombinant fusionprotein or pharmaceutical composition comprising the same isadministered to a subject two or more times a year. In anotherembodiment, a dose of the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered to a subject two or moretimes every two years. In another embodiment, a dose of the recombinantfusion protein or pharmaceutical composition comprising the same isadministered to a subject two or more times every two or more years.

In another embodiment, a dose of the recombinant fusion protein orpharmaceutical composition comprising the same is administered at leastonce every 36 hours. In another embodiment, a dose of the recombinantfusion protein or pharmaceutical composition comprising the same isadministered at least once every 48 hours. In another embodiment, a doseof the recombinant fusion protein or pharmaceutical compositioncomprising the same is administered at least once every 60 hours. Inanother embodiment, a dose of the recombinant fusion protein orpharmaceutical composition comprising the same is administered at leastonce every 72 hours. In another embodiment, a dose of the recombinantfusion protein or pharmaceutical composition comprising the same isadministered at least once every 84 hours. In another embodiment, a doseof the recombinant fusion protein or pharmaceutical compositioncomprising the same is administered at least once every 96 hours. Inanother embodiment, a dose of the recombinant fusion protein orpharmaceutical composition comprising the same is administered at leastonce every 5 days. In another embodiment, a dose of the recombinantfusion protein or pharmaceutical composition comprising the same isadministered at least once every 6 days. In another embodiment, a doseof the recombinant fusion protein or pharmaceutical compositioncomprising the same is administered at least once every 7 days. Inanother embodiment, a dose of the recombinant fusion protein orpharmaceutical composition comprising the same is administered at leastonce every 8-10 days. In another embodiment, a dose of the recombinantfusion protein or pharmaceutical composition comprising the same isadministered at least once every 10-12 days. In another embodiment, adose of the recombinant fusion protein or pharmaceutical compositioncomprising the same is administered at least once every 12-15 days. Inanother embodiment, a dose of the recombinant fusion protein orpharmaceutical composition comprising the same is administered at leastonce every 15-25 days. In another embodiment, a dose of the recombinantfusion protein or pharmaceutical composition comprising the same isadministered at least once every 20-30 days.

In one embodiment, a dose of the recombinant fusion protein orpharmaceutical composition comprising the same is administered to asubject at least once every 1 month. In one embodiment, a dose of therecombinant fusion protein or pharmaceutical composition comprising thesame is administered at least once every 2 months. In one embodiment, adose of the recombinant fusion protein or pharmaceutical compositioncomprising the same is administered at least once every 3 months. In oneembodiment, a dose of the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered at least once every 4months. In one embodiment, a dose of the recombinant fusion protein orpharmaceutical composition comprising the same is administered at leastonce every 5 months. In one embodiment, a dose of the recombinant fusionprotein or pharmaceutical composition comprising the same isadministered at least once every 6 months. In one embodiment, a dose ofthe recombinant fusion protein or pharmaceutical composition comprisingthe same is administered at least once every 6-12 months. In anotherembodiment, a dose of the recombinant fusion protein or pharmaceuticalcomposition comprising the same is administered quarterly. In anotherembodiment, the dose is administered daily, weekly, biweekly, monthly orannually. In another embodiment, the dose is administered once, twice,or two or more times a day, a week, a month or a year. In anotherembodiment, the dose is administered every two, three, four, or at leastfive years.

In one embodiment, repeat administrations (doses) of compositions ofthis invention may be undertaken immediately following the first courseof treatment or after an interval of days, weeks, or years to achievethe desired effect as further provided herein (e.g. to prevent or treatcardiovascular disease or condition, or a CNS-related disease orcondition).

In one embodiment, the pharmaceutical compositions are administered byintravenous, intra-arterial, subcutaneous or intramuscular injection ofa liquid preparation. In another embodiment, liquid formulations includesolutions, suspensions, dispersions, emulsions, oils and the like. Inone embodiment, the pharmaceutical compositions are administeredintravenously, and are thus formulated in a form suitable forintravenous administration. In another embodiment, the pharmaceuticalcompositions are administered intra-arterially, and are thus formulatedin a form suitable for intra-arterial administration.

In some embodiments, compositions for use in the methods disclosedherein comprise solutions or emulsions, which in some embodiments areaqueous solutions or emulsions comprising a safe and effective amount ofthe compounds disclosed herein and optionally, other compounds, intendedfor intravenous or subcutaneous administration.

In some embodiments, the various constituents of the compositions comepre-measured and/or prepackaged and/or ready for use without additionalmeasurement, etc. The present invention also optionally comprises kitsfor conducting/using the methods and/or the compositions of theinvention. In particular, these kits optionally include, e.g.,appropriate recombinant fusion protein (and optionally mixtures of anumber of such proteins for performing synergistic treatments, see,above), and optionally appropriate disease related antigen(s) as well).Additionally, such kits can also comprise appropriate excipients (e.g.,pharmaceutically acceptable excipients) for performing therapeuticand/or prophylactic treatments of the invention. Such kits optionallycontain additional components for the assembly and/or use of thecompositions of the invention including, but not limited to, e.g.,diluents, etc.

The compositions described herein are optionally packaged to include all(or almost all) necessary components for performing the methods of theinvention or for using the compositions of the invention (optionallyincluding, e.g., written instructions for the use of themethods/compositions of the invention). For example, the kits canoptionally include such components as, e.g., buffers, reagents, serumproteins, antibodies, substrates, etc. In the case of prepackagedreagents, the kits optionally include pre-measured or pre-dosed amountsthat are ready to incorporate into the methods without measurement,e.g., pre-measured fluid aliquots, or pre-weighed or pre-measured solidreagents that can be easily reconstituted by the end-user of the kit.

Such kits also typically include appropriate instructions for performingthe methods of the invention and/or using the compositions of theinvention. In some embodiments, the components of the kits/packages areprovided in a stabilized form, so as to prevent degradation or otherloss during prolonged storage, e.g., from leakage. A number ofstabilizing processes/agents are widely used for reagents, etc. that areto be stored, such as the inclusion of chemical stabilizers (i.e.,enzymatic inhibitors, microbicides/bacteriostats, anticoagulants), etc.Actual dosage levels of the active ingredients in the pharmaceuticalcompositions of the present invention may be varied so as to obtain anamount of the active ingredient which is effective to achieve thedesired therapeutic response for a particular subject, composition, andmode of administration, without being toxic to the subject. The selecteddosage level will depend upon a variety of pharmacokinetic factorsincluding the activity of the particular compositions of the presentinvention employed, the route of administration, the time ofadministration, the rate of excretion of the particular compound beingemployed, the duration of the treatment, other drugs, compounds and/ormaterials used in combination with the particular compositions employed,the age, sex, weight, condition, general health and prior medicalhistory of the subject being treated, and like factors well known in themedical arts.

The composition must be sterile and fluid to the extent that thecomposition is deliverable by syringe. In addition to water, the carrierpreferably is an isotonic buffered saline solution. Proper fluidity canbe maintained, for example, by use of coating such as lecithin, bymaintenance of required particle size in the case of dispersion and byuse of surfactants. In many cases, it is preferable to include isotonicagents, for example, sugars, polyalcohols such as mannitol or sorbitol,and sodium chloride in the composition.

Actual dosage levels of the active ingredients in the pharmaceuticalcompositions of the present invention may be varied so as to obtain anamount of the active ingredient which is effective to achieve thedesired therapeutic response for a particular subject, composition, andmode of administration, without being toxic to the subject. The selecteddosage level will depend upon a variety of pharmacokinetic factorsincluding the activity of the particular compositions of the presentinvention employed, the route of administration, the time ofadministration, the rate of excretion of the particular compound beingemployed, the duration of the treatment, other drugs, compounds and/ormaterials used in combination with the particular compositions employed,the age, sex, weight, condition, general health and prior medicalhistory of the subject being treated, and like factors well known in themedical arts.

While several inventive embodiments have been described and illustratedherein, those of ordinary skill in the art will readily envision avariety of other means and/or structures for performing the functionand/or obtaining the results and/or one or more of the advantagesdescribed herein, and each of such variations and/or modifications isdeemed to be within the scope of the inventive embodiments describedherein. More generally, those skilled in the art will readily appreciatethat all parameters, dimensions, materials, and configurations describedherein are meant to be exemplary and that the actual parameters,dimensions, materials, and/or configurations will depend upon thespecific application or applications for which the inventive teachingsis/are used. Those skilled in the art will recognize, or be able toascertain using no more than routine experimentation, many equivalentsto the specific inventive embodiments described herein. It is,therefore, to be understood that the foregoing embodiments are presentedby way of example only and that within the scope of the appended claimsand equivalents thereto, inventive embodiments may be practicedotherwise than as specifically described and claimed. Inventiveembodiments of the present disclosure are directed to each individualfeature, system, article, material, kit, and/or method described herein.In addition, any combination of two or more such features, systems,articles, materials, kits, and/or methods, if such features, systems,articles, materials, kits, and/or methods are not mutually inconsistent,is included within the inventive scope of the present disclosure.

All definitions, as defined and used herein, should be understood tocontrol over dictionary definitions, definitions in documentsincorporated by reference, and/or ordinary meanings of the definedterms.

All references, patents and patent applications disclosed herein areincorporated by reference with respect to the subject matter for whicheach is cited, which in some cases may encompass the entirety of thedocument.

The indefinite articles “a” and “an,” as used herein in thespecification and in the claims, unless clearly indicated to thecontrary, should be understood to mean “at least one.”

The phrase “and/or,” as used herein in the specification and in theclaims, should be understood to mean “either or both” of the elements soconjoined, i.e., elements that are conjunctively present in some casesand disjunctively present in other cases. Multiple elements listed with“and/or” should be construed in the same fashion, i.e., “one or more” ofthe elements so conjoined. Other elements may optionally be presentother than the elements specifically identified by the “and/or” clause,whether related or unrelated to those elements specifically identified.Thus, as a non-limiting example, a reference to “A and/or B”, when usedin conjunction with open-ended language such as “comprising” can refer,in one embodiment, to A only (optionally including elements 5 other thanB); in another embodiment, to B only (optionally including elementsother than A); in yet another embodiment, to both A and B (optionallyincluding other elements); etc.

As used herein in the specification and in the claims, the phrase “atleast one,” in reference to a list of one or more elements, should beunderstood to mean at least one element selected from any one or more ofthe elements in the list of elements, but not necessarily including atleast one of each and every element specifically listed within the listof elements and not excluding any combinations of elements in the listof elements. This definition also allows that elements may optionally bepresent other than the elements specifically identified within the listof elements to which the phrase “at least one” refers, whether relatedor unrelated to those elements specifically identified. Thus, as anon-limiting example, “at least one of A and B” (or, equivalently, “atleast one of A or B,” or, equivalently “at least one of A and/or B”) canrefer, in one embodiment, to at least one, optionally including morethan one, A, with no B present (and optionally including elements otherthan B); in another embodiment, to at least one, optionally includingmore than one, B, with no A present (and optionally including elementsother than A); in yet another embodiment, to at least one, optionallyincluding more than one, A, and at least one, optionally including morethan one, B (and optionally including other elements); etc.

The present invention further provides a kit for preventing, treating ordelaying a cardiovascular disease or condition in a human, wherein thekit comprises one or more doses of pharmaceutical composition comprisinga recombinant fusion protein disclosed herein used for preventing,treating or delaying a cardiovascular disease or condition, andinstructions on how to use the pharmaceutical preparation orcomposition.

The present invention further provides a kit for preventing, treating ordelaying a CNS-related disease or condition in a human, wherein the kitcomprises one or more doses of pharmaceutical composition comprising arecombinant fusion protein disclosed herein used for preventing,treating or delaying a cardiovascular disease or condition, andinstructions on how to use the pharmaceutical preparation orcomposition.

The present invention further provides a kit for preventing, treating ordelaying heart failure with preserved ejection fraction in a human,wherein the kit comprises one or more doses of pharmaceuticalcomposition comprising a recombinant fusion protein disclosed hereinused for preventing, treating or delaying heart failure with preservedejection fraction, and instructions on how to use the pharmaceuticalpreparation or composition.

The following examples are presented in order to more fully illustratethe preferred embodiments of the invention. They should in no way beconstrued, however, as limiting the broad scope of the invention.

EXAMPLES Example 1 Cloning and Construction of Expression Plasmids

DNA sequences encoding the recombinant fusion proteins' heavy chain(named NPCFA and NPCF for the sequences with or without Fc mutations,respectively) and light chain (named PAL) were synthesized by GENEWIZ(Suzhou, China). Expression vector pCHOGUN was obtained from HorizonDiscovery (Cambridge, UK) under a licensing agreement. Construction ofthe expression plasmids is carried out as outlined in FIG. 1. Briefly,pCHOGUN vector was linearized by restriction enzyme BfuAI and geneinsert fragments such as NPCF, NPCFA, and PAL were purified followingdouble restriction enzyme digestion by NcoI and AscI. The linearizedpCHOGUN/BfuAI and the purified gene insert fragment were ligated perstandard protocol and then transformed into E. coli DH5α competentcells. DH5α cells were plated and incubated overnight at 37° C. PlasmidspCHOGUN-NPCF, pCHOGUN-NPCFA and pCHOGUN-PAL were isolated and confirmedby restriction enzyme digestion or PCR. The plasmid containing the heavychain insert (pCHOGUN-NPCF or pCHOGUN-NPCFA) was digested withrestriction enzymes BspEI and PciI, whereas the plasmid containing thelight chain insert (pCHOGUN-PAL) was digested with restriction enzymesNgoMIV and PciI. Following the restriction enzyme digestion, thefragments with the heavy or light chain insert were purified, ligatedand then transformed into DH5α cells. The plasmid constructs containingboth the heavy and light chain inserts (pCHOGUN-NPCF+PAL orpCHOGUN-NPCFA+PAL) were identified and confirmed by restriction enzymedigestion and DNA sequencing.

Example 2 Antibody Production, Purification and Characterization

HD-BIOP3, a glutamine synthetase-null (GS^(−/−)) cell line derived fromCHO K1 cells, was obtained from Horizon Discovery (Cambridge, UK) undera licensing agreement. Plasmid DNA is isolated using commerciallyavailable Qiagen Plasmid Kits. Transfection of the plasmid DNA intoHD-BIOP3 cells was performed using a commercially availableelectroporation system from Lonza. The transfected cells were plated in96-well plates and underwent pool selection using standard procedures.Cells from the selected pools were cultured in 125-mL shake flasks for10-14 days and the media were harvested for antibody purification.Antibody proteins were purified by protein-A affinity chromatographyfollowed by size-exclusion chromatography and then analyzed withSDS-PAGE and Western blot according to standard protocols.

FIG. 2A illustrates the schematic structure of the recombinant fusionprotein disclosed herein. FIG. 2B shows representative data generated bySDS-PAGE analysis. Western blot results detected by primary antibodyspecific for the 61-amino acid active fragment of NRG-1 comprising theHER3/4 binding domain (“NRG-1”, R&D Systems, Minneapolis, Minn.) or IgGare shown in FIGS. 2C and 2D, respectively.

Example 3 Molecular Integrity Assessed by SPR-Based Binding Assay

Molecular structure integrity of the recombinant fusion proteindisclosed herein is assessed by evaluating its concurrent bindingability to HER3 protein and Anti-NRG-1 antibody. His-tagged HER3recombinant protein (Sino Biological, Beijing, China) was captured onthe sensor chip immobilized with anti-His antibody (Thermo Fisher,Waltham, Mass.) (Step 1), followed by the injection of samples(including the recombinant fusion protein disclosed herein, therecombinant fusion protein disclosed herein without Fc mutations,anti-HER3 mAb (Step 2), and anti-NRG-1 antibody (R&D Systems,Minneapolis, Minn.) (Step 3). The attachment of His-HER3 on the sensorchip can be visualized through the increase of signal on all 6 channelsin step 1. Both the recombinant fusion protein disclosed herein and therecombinant fusion protein disclosed herein without Fc mutationsgenerated significant response on step 2 by binding to HER3 and on step3 by binding to injected anti-NRG-1 antibody (Ch1, 3), indicating thepresence of HER3-binding epitope and NRG-1 on the recombinant fusionprotein disclosed herein. In contrast, the anti-HER3 mAb bound only toHis-HER3 on step 2, but not Anti-NRG-1 antibody and buffer (Step 3) (Ch4, 5), verifying the absence of NRG-1-binding activity for the anti-HER3mAb molecule. Buffer was injected at Step 2 and 3 as blank control.Therefore, both the HER3-binding epitope and NRG-1 are present in therecombinant fusion protein of the invention.

The binding sensorgram and sample injection sequences are shown in FIG.3.

Example 4 Effect on Tumor Cell Line Proliferation In Vitro

Tumor cells were seeded in 96-well plates at 2,500-20,000 cells perwell, depending on the growth kinetics of each cell line. Cells werethen treated with the recombinant fusion protein disclosed herein,antibody or control protein in a step-wise 1:4 serial dilution seriesfor 5 days. Cell viability was assessed using Cell Counting Kit-8 fromDojindo Molecular Technologies (Kumamoto, Japan) according to themanufacturer's instructions. Data were analyzed with GraphPad Prismsoftware and are presented as the rate of growth relative to theuntreated control.

FIG. 4 includes representative graphs showing the mean relative growthrate±SEM (n=3) for different cancer cell lines: (A) NCI-N87, gastric;(B) MCF-7, breast; (C) RT-112, bladder; and (D) T47D, breast. Comparedto the control NRG-1 and GP120 mAb/NRG-1 fusion proteins, therecombinant fusion protein disclosed herein demonstrates markedly loweractivity in promoting cancer cell proliferation.

Example 5 Activation of PI3K/AKT Signaling Pathway in HumanCardiomyocytes

Human cardiomyocytes obtained from Cellular Dynamics (Madison, Wis.)were seeded in 0.1% gelatin-coated 96-well plates and recovered in theplating medium (Cellular Dynamics) for 4 hours. Cells were then culturedin the maintaining medium (Cellular Dynamics) for 96 hours before usedfor experimentation. To examine the ability of the recombinant fusionprotein of the invention to activate the HER2:HER4 signaling pathway incardiomyocytes, cells were first starved for 4 hours in serum-free mediaand then treated with the recombinant fusion protein or control agents(NRG-1, GP120 mAb/NRG-1, anti-HER3 mAb, or GP120 mAb) in a step-wise 1:4serial dilution series for 15 minutes. At the end of treatment, cellswere lysed and analyzed for AKT phosphorylation using Abcam'sPhospho-AKT/Total AKT ELISA Kit (Cambridge, Mass.) following themanufacturer's instructions. Data were analyzed with GraphPad Prismsoftware and are presented as the ratio of phospho-AKT to total AKTrelative to the untreated control.

For western blot analysis, cells were seeded in 6-well plates andtreated with the recombinant fusion protein of the invention or controlagents at a single concentration of 16 nM. At the end of treatment,cells were lysed in RIPA lysis buffer containing protease andphosphatase inhibitors. SDS-PAGE and Western blot were conducted perstandard protocols. The total AKT and phosphor-AKT were blotted with AKTrabbit antibody and p-AKT(S473) rabbit antibody (Cell Signaling;Danvers, Mass.), respectively.

FIGS. 5A-5B show AKT phosphorylation in response to stimuli in humancardiomyocytes. Results suggest that the recombinant fusion proteindisclosed herein can activate the HER2:HER4 signaling pathway incardiomyocytes with a potency comparable to NRG-1.

Example 6 Induction of HER2:HER3 Dimerization and HER2:HER4 Dimerization

PathHunter Dimerization Assay developed by Eurofins DiscoverX (Fremont,Calif.) detects ligand induced dimerization of two subunits of areceptor-dimer pair. The assay principle is illustrated in FIG. 6A.β-gal enzyme is split into two fragments, ProLink (PK) and enzymereceptor (EA). The cells have been engineered to co-express targetprotein 1 fused to enzyme donor PK, and target protein 2 fused to enzymeacceptor EA. Binding of ligand to one target protein induces it tointeract with the other target protein, forcing complementation of thetwo enzyme fragments and resulting in the enzyme reaction to releasechemiluminescent signal which is detected as Relative Fluorescence Unitor RFU.

PathHunter U2OS ErbB2/ErbB4 dimerization cell line and ErbB2/ErbB3dimerization cell line were obtained from Eurofins DiscoverX. Cells wereseeded at 4,000 cells/well in 384-well plates and incubated at 37° C./5%CO₂ overnight. Testing agents were prepared in a step-wise 1:4 serialdilution series starting from 28.8 nM, and then added to cells in384-well plates. After 4 hours of incubation, cells were assayed forreceptor dimerization according to the manufacturer's instructions. Datawere analyzed with GraphPad Prism software and are presented as meanRFU±SEM (n=3).

As shown in FIGS. 6B and 6C, the recombinant fusion protein disclosedherein can induce HER2/HER4 dimerization with potency comparable toNRG-1; whereas its ability to induce HER2/HER3 dimerization is muchweaker. As negative controls for the study, neither the isotype controlantibody GP120 mAb nor the anti-HER3 mAb induced receptor dimerization.

Having described embodiments of the invention with reference to theaccompanying drawings, it is to be understood that the invention is notlimited to the precise embodiments, and that various changes andmodifications may be effected therein by those skilled in the artwithout departing from the scope or spirit of the invention as definedin the appended claims.

Example 7 In Vivo Efficacy of the Recombinant Fusion Protein in a RatModel of Systolic Heart Failure

To evaluate the ability of the recombinant fusion protein to regeneratecardiac function in a disease model, a Sprague Dawley rat model ofmyocardial infarction and systolic heart failure was employed. Toestablish the disease model, a 6-0 silk suture was used to ligate theleft anterior descending coronary artery (LAD) 3-4 mm below the leftatrial appendage in a surgical procedure. Four weeks following ligation,the ejection fraction (EF) was recorded by M-mode echocardiography (ECG)Doppler ultrasound to measure cardiac function against the baseline EFprior to surgery. A threshold of minimum 30% decrease of EF was used forinclusion in the subsequent study. Sham control animals underwent anidentical surgery without the LAD ligation.

After establishing the disease model, animals were divided into fivegroups of eleven rats each, with an additional ten sham-surgery ratsincluded in a sixth group. The study was designed for each group toreceive twice-weekly tail vein injections for a period of four weeks, oreight total injections. Both the sham surgery group and the negativecontrol of vehicle group received saline, three groups received therecombinant fusion protein at 1, 3, or 10 mg/kg, and the final groupreceived a positive control of GP120 mAb/NRG-1 fusion protein (10mg/kg).

Due to the body-weight loss observed during the study, treatment wasdiscontinued prior to the full sequence of eight injections in therecombinant fusion protein groups receiving 3 mg/kg and 10 mg/kg, withthose groups receiving only six and three injections respectively. Allother groups received the full set of eight injections.

Four weeks following the first treatment, EF was again measured byM-mode ECG. As shown in FIG. 8, relative to baseline the recombinantfusion protein significantly increased the EF in all three dose groups.Specifically, increases of 14.7% (P<0.001), 26.9% (P<0.001), and 36.6%(P<0.001) were observed for the 1, 3, and 10 mg/kg groups respectively.The GP120 mAb/NRG-1 positive control increased EF by 28.8% (P<0.001) atthe matched time point. Saline showed no effect in either the shamcontrol group or the vehicle control group.

Following the collection of ECG values at 28 days post-treatment, micewere euthanized and the cardiac tissues next to the surgical site werecollected, fixed in 4% formaldehyde, and embedded in paraffin. Five μmthick paraffin sections of the heart tissues were stained withhematoxylin and eosin dyes, and histopathological changes were observedunder a light microscope. As shown in FIG. 9, in the sham operationgroup, the cardiomyocytes were arranged in an orderly fashion and thecytoplasm and the myocardial fibers were evenly stained. No inflammatorycell infiltration was observed in the interstitial spaces and nomyocardial necrosis was found. In contrast, in the vehicle controlgroup, the myocardial infarction marginal zone exhibited widened gapsbetween myocardial cells; the nuclei were condensed and shattered andthe myocardial fiber arrangement lost its ordered structure; the cellsize was enlarged and the interstitial edema was noticed. Treatment withthe recombinant fusion protein partially alleviated the pathologicalchanges in the myocardial infarction zone, including significantreduction of necrotic cells, narrowed interstitial spaces betweenmyocardial cells, and recovery of myocardial fiber arrangement towardsnormal structure.

Example 8 The Recombinant Fusion Protein Attenuated Tumor Growth inSubcutaneous FaDu Carcinoma Xenograft Model in NOD/SCID Mice

To evaluate the potential risk of the recombinant fusion protein inpromoting tumor growth, an in vivo study in a FaDu carcinoma xenograftmodel was carried out. NOD/SCID mice (Beijing AK Bio-Technology Co.Ltd.) were maintained in SPF facility at the CrownBio international R&Dcenter (Beijing, China) in accordance with institutional guidelines. Allexperiments were performed in accordance with the requirements of theAssociation for Assessment and Accreditation of Laboratory Animal Care(AAALAC) and with the permission of the CrownBio IACUC Committee.

Female NOD/SCID mice, age 7-10 weeks, were inoculated subcutaneously inthe right flank with FaDu tumor cells (3×10⁶) suspended in 0.1 ml ofPBS. When tumors reached approximately 150 mm³, mice were randomized andsorted into 6 study groups with 8 animals per group. Test samples wereadministrated intravenously by tail vein injection twice a week forthree consecutive weeks, for a total of 6 treatments. Tumor growth wasmonitored by caliper measurements. The study was terminated at 21 dayspost-treatment.

The tumor growth in response to different treatments is summarized inFIG. 10. Anti-HER3 mAb at 10 mg/kg showed significant anti-tumoractivity with a tumor growth inhibition (TGI) of 93.5% at the end ofstudy (p<0.001 vs. vehicle group). The recombinant fusion protein alsodemonstrated a statistically significant TGI at the end of the study:19.2% at 1 mg/kg dosage (p=0.048 vs. vehicle group) and 56.2% at 10mg/kg dosage (p<0.001 vs. vehicle group). The control molecule GP120mAb/NRG-1 fusion protein showed no anti-tumor activity at either thehigh or low dose. No animal deaths occurred during the study. All testagents were well-tolerated by the tumor-bearing mice. There was nosignificant body-weight loss observed in any experimental group (FIG.11). These data show that under the condition of active tumor growth invivo, the recombinant fusion protein exhibits tumor growth inhibition ina dose-dependent manner, and suggests that the risk of the recombinantfusion protein augmenting or accelerating tumor growth in vivo is lowerthan the native NRG-1 protein.

Example 9 No Significant Gastrointestinal Toxicity Observed inCynomolgus Monkeys Administrated with the Recombinant Fusion Protein

It was previously reported that in a Phase One clinical study(NCT01258387) in which subjects received either placebo or single-doseadministration of cimaglermin (full-length recombinant NRG-1β3), nauseaand diarrhea were the second and fourth most common treatment-emergentadverse events, occurring in 40% and 27% of the aggregated high-dosecohorts respectively (Lenihan et al. J Am Coll Cardiol Basic TransScience. 2016; 1(7):576-86). Similarly, in a Phase Two study of arecombinant NRG-1 peptide fragment (neucardin), nausea was the mostcommonly observed treatment-related adverse event, seen in 20% of thestudy subjects (Jabbour et al. European Journal of Heart Failure (2011)13: 83-92). Finally, in a second Phase Two study of neucardin(ChiCTR-TRC-00000414), published results show 48.4% of the adverseevents observed were gastrointestinal in nature, the most frequentlyobserved type of adverse events in this study, and correlated withdose-level (Gao et al. J Am Coll Cardiol 2010; 55:1907-14).

Two studies to evaluate the safety and tolerability of the recombinantfusion protein in cynomolgus macaques (Macaca fascicularis) wereconducted: a single-dose non-GLP (good laboratory practice) study and arepeat-dose GLP study. Gastrointestinal toxicities were closelymonitored. In the single-dose study, the safety and tolerability of therecombinant fusion protein was evaluated at dose levels of 10, 30, and60 mg/kg in comparison to vehicle control, with one male and one femaleanimal included in each cohort. In this single-dose study there were notest agent-related effects on body weight or qualitative food evaluationthroughout the post-treatment evaluation period of two weeks, and noobservations of vomiting or diarrhea. In the repeat-dose GLP study, thesafety and tolerability of the recombinant fusion protein was evaluatedfollowing four consecutive weekly administrations at dose levels of 3,10, and 30 mg/kg in comparison to vehicle control, with three males andthree females included in each cohort for the main 28-day study period,and an additional two males and two females in the 30 mg/kg and vehiclecontrol cohorts evaluated following a subsequent 28-day recovery period.There were no test agent-related effects on food consumption observed inthis repeat-dose study. While there was test agent-related vomitingobserved in this repeat-dose study, clinical observations of vomitingwere only associated with infusion reactions, only observed in oneanimal in the 10 mg/kg cohort (17%) and two animals in the 30 mg/kgcohort (20%), and were transient in nature. Diarrhea was observed onlyin the vehicle control cohort and 30 mg/kg recombinant fusion proteincohort, in only one (10%) and three (30%) animals respectively, and wasconsidered normal for this type of procedure and unrelated to therecombinant fusion protein. Finally, in this repeat-dose study, averagebody weight was reduced by >10% relative to baseline only at the 10mg/kg and 30 mg/kg dose levels, and only following the fourth dose inthe 10 mg/kg cohort and the third and fourth doses in the 30 mg/kgcohort. In summary, treatment with the recombinant fusion protein didnot result in any clinically significant findings related to foodintake, vomiting, or diarrhea other than during acute infusionreactions, and gastrointestinal findings had no impact on thedetermination of the no-adverse event level in either study. Theseresults indicate that the design of the recombinant fusion proteinmitigates the adverse effect of NRG-1 recombinant protein on thegastrointestinal tract.

Blood samples (˜1 ml) were collected from cynomolgus monkeys followingsingle-dose administration of 60 mg/kg of the recombinant fusion proteinat different time points, and sera were extracted and stored at −80° C.until tested. The concentrations of the recombinant fusion protein inthe serum samples were assayed by capture ELISA according to standardprocedures. Briefly, 96-well plates were coated with the recombinanthuman HER3 protein (R&D System), blocked with BSA, and incubated withtest samples. After multiple washes, plates were incubated withHRP-conjugated anti-human IgG Fc antibody and then detected with TMBsubstrate. FIG. 12 shows that the pharmacokinetic profile of therecombinant fusion protein is similar to IgG antibody.

Example 10 Summary of Kinetic Constants on Fc Receptor Binding

The binding affinity between the recombinant anti-HER3 mAb/NRG-1 fusionprotein and Fc receptors were measured using label-free SPR technique. Atotal of six Fc receptors (each fused with a His-tag), including FcγRI(Abcam), FcγRIIa, FcγRIIb, FcγRIIIa (158F), FcγRIIIa (158V), and C1q(Sino Biological), were analyzed against the recombinant fusion protein,the recombinant fusion protein without Fc mutations and anti-HER3antibody, respectively. All Fc receptors and test samples were purifiedby affinity chromatography. All experiments were performed on Biacore 8Ksystems (GE Healthcare), with HBS-EP+ (10 mM HEPES, 150 mM NaCl, 3 mMEDTA and 0.05% v/v Surfactant P20) as the running buffer. Specifically,anti-His antibody was coupled in both the active and reference flow cellof a CMS sensor chip by the amine coupling method. Purified His-taggedFc receptors were captured on the active flow cell of each individualchannel through binding to immobilized anti-His antibody. Capture levelfor each Fc receptor was maintained between 80-120 RU. For kineticanalysis, the recombinant fusion protein and all other samples wereserially diluted to a total of 6 concentrations, ranging from 0.3 nM to30 nM, and the serial dilutions were injected in sequence through bothflow cells in each channel. Multiple analyses were completed in the samerun by simultaneously injecting samples over multiple channels.

The resulting sensorgrams were fitted with a two-state binding model toextract kinetic constants using Biacore 8K Evaluation Software.Equilibrium dissociation rates (KD) of all analyses are summarized inTable 1 below. Kinetically derived KD values of the recombinant fusionprotein binding to FcγRI, FcγRIIa and FcγRIIb, were more than 10-foldhigher than those of the recombinant fusion protein without Fc mutationsand the anti-HER3 antibody, indicating much lower affinities as a resultof the specified mutations within the Fc region of the recombinantfusion protein. With FcγRIIIa (158F) and FcγRIIIa (158V), respectively,Fc mutations led to 2 to 3-fold reduction in binding affinity for therecombinant fusion protein. Binding to C1q was too weak to be detectedfor all samples.

To confirm that the recombinant fusion protein has limited Fc effectorfunctions, antibody-dependent cellular cytotoxicity (ADCC) was examinedusing the ADCC Reporter Bioassay from Promega (Madison, Wis.). The assayused an engineered Jurkat cell line as effector cells, which stablyexpressed the FcγRIIIa (V158) receptor and an NFAT response element thatdrives the expression of firefly luciferase. Rituximab, as the positivecontrol for the assay, showed strong ADCC activity against CD20-positiveRaji cells; whereas the recombinant fusion protein had no detectableADCC against HER3-positive target cells (MCF7 or BT474) (data notshown).

TABLE 1 Summary of kinetic constants on Fc receptors binding KD (M)Anti-HER3 Anti-HER3 mAb/NRG-1 (w/o Fc Anti-HER3 Fc Receptors mAb/NRG-1mutations) mAb FcγRI 1.03E−08 2.81E−09 4.56E−09 FcγRIIa 1.35E−063.95E−07 1.50E−07 FcγRIIb 1.52E−06 1.03E−07 1.04E−08 FcγRIIIa (158F)1.18E−07 6.37E−08 1.66E−07 FcγRIIIa (158V) 9.10E−08 3.41E−08 3.80E−08C1q <LOD* <LOD* <LOD* *<LOD - Below limit of detection (LOD) due to weakbinding

What is claimed is:
 1. A recombinant fusion protein comprising afragment of the cardioprotective protein neuregulin-1 (NRG-1) fused to amonoclonal antibody (mAb) backbone.
 2. The recombinant fusion protein ofclaim 1, wherein the NRG-1 fragment comprises an active fragment.
 3. Therecombinant fusion protein of claim 2, wherein the active proteinfragment of NRG-1 comprises the active domain of NRG-1.
 4. Therecombinant fusion protein of any one of claims 1-3, wherein the mAb ismonospecific for ErbB3 (HER3).
 5. The recombinant fusion protein of anyone of claims 1-4, wherein the NRG-1 fragment comprises the ERBB3/4binding domain.
 6. The recombinant fusion protein of any one of claims1-5, wherein the NRG-1 fragment binds to and induces signaling throughErbB4 (HER4).
 7. The recombinant fusion protein of claim 6, wherein themAb inhibits NRG-1 signaling through ErbB3 (HER3).
 8. The recombinantfusion protein of any one of claims 1-7, wherein said NRG-1 fragmentcomprises the NRG-1 β2a isoform.
 9. The recombinant fusion protein ofany one claims 1-8, wherein the NRG-1 fragment is fused via itsN-terminal amino acid to the C-terminus of the antibody heavy chainusing a linker.
 10. The recombinant fusion protein of claim 9, whereinsaid linker comprises at least one copy of aGly-Gly-Gly-Gly-Ser-Gly-Gly-Gly-Gly-Ser linker set forth in SEQ ID NO:5.
 11. The recombinant fusion protein of claim 9, wherein the C-terminusof the antibody heavy chain comprises the Fc domain of the antibody. 12.The recombinant fusion protein of any one of claims 1-11, wherein themonoclonal antibody is glycosylated.
 13. The recombinant fusion proteinof claim 12, wherein the glycosylation is N-glycosylation.
 14. Therecombinant fusion protein of claim 12, wherein the glycosylation isO-glycosylation.
 15. The recombinant fusion protein of any one of claims1-14, wherein the NRG-1 fragment comprises the amino acid sequence ofSEQ ID NO:
 4. 16. The recombinant fusion protein of any one of claims1-15, wherein the mAb comprises a heavy chain represented by the aminoacid sequence of SEQ ID NO:
 2. 17. The recombinant fusion protein of anyone of claims 1-16, wherein the mAb comprises a light chain representedby the amino acid sequence of SEQ ID NO:
 3. 18. The recombinant fusionprotein of claim 16, wherein the mature mAb comprises a substitutionmutation in at least one of amino acids 234, 239 and 434 of SEQ ID NO:2.
 19. The recombinant fusion protein of claim 18, wherein the at leastone substitution mutation comprises a L234F mutation, a S239A mutation,a N434A mutation, or a combination thereof.
 20. The recombinant fusionprotein of any one of claims 1-19, wherein the recombinant fusionprotein comprises the amino acid sequences of SEQ ID NO: 3 and SEQ IDNO:
 14. 21. The recombinant fusion protein of any one of claims 1-20,wherein the recombinant fusion protein attenuates proliferation of tumoror cancer cells relative to recombinant NRG-1.
 22. The recombinantfusion protein of any one of claims 1-21, wherein the recombinant fusionprotein promotes cardiomyocyte proliferation, differentiation, andsurvival.
 23. The recombinant fusion protein of any one of claims 1-22,wherein the recombinant fusion protein promotes proliferation,differentiation and survival of cardiac tissue.
 24. The recombinantfusion protein of any one of claims 1-23, wherein the recombinant fusionprotein promotes proliferation, differentiation and survival of centralnervous system (CNS) cells.
 25. The recombinant fusion protein of anyone of claims 1-24, wherein the recombinant fusion protein has a reducedcapacity to induce antibody-dependent cell cytotoxicity (ADCC).
 26. Therecombinant fusion protein of any one of claims 1-25, wherein therecombinant fusion protein promotes HER2/4 signaling over HER2/3signaling relative to the signal induction potential of recombinantNRG-1.
 27. A recombinant nucleic acid molecule encoding the recombinantfusion protein of any one of claims 1-26.
 28. A recombinant vectorcomprising the nucleic acid molecule of claim
 27. 29. A recombinant cellcomprising the recombinant vector of claim
 28. 30. A pharmaceuticalcomposition comprising the recombinant fusion protein of anyone ofclaims 1-26.
 31. A method of treating a cardiovascular disease orcondition in a subject in need thereof, the method comprisingadministering a therapeutically effective amount of the recombinantfusion protein of any one of claims 1-26 or the pharmaceuticalcomposition of claim
 30. 32. The method of claim 31, wherein thetreatment alleviates a sign or a symptom of the cardiovascular diseaseor condition in the subject.
 33. A method of preventing, inhibiting,suppressing or delaying the onset of a cardiovascular disease orcondition in a subject, the method comprising administering an effectiveamount of the recombinant fusion protein of any one of claims 1-26 orthe pharmaceutical composition of claim
 30. 34. A method of treating aCNS-related disease or condition in a subject in need thereof, themethod comprising administering a therapeutically effective amount ofthe recombinant fusion protein of any one of claims 1-26 or thepharmaceutical composition of claim
 30. 35. The method of claim 34,wherein the treatment alleviates a sign or a symptom of the CNS-relateddisease or condition in the subject.
 36. A method of preventing,inhibiting, suppressing or delaying the onset of a CNS-related diseaseor condition in a subject, the method comprising administering aneffective amount of the recombinant fusion protein of any one of claims1-26 or the pharmaceutical composition of claim
 30. 37. The method ofany one of claims 31-33, wherein the cardiovascular disease or conditionis Chronic heart failure/Congestive heart failure (CHF), Acute heartfailure/Myocardial infarction (MI), Left ventricular systolicdysfunction, Reperfusion injury associated with MI, Chemotherapy-inducedcardiotoxicity (adult or pediatric), Radiation-induced cardiotoxicity,Adjunct to surgical intervention in pediatric congenital heart disease.38. The method of claim 37, wherein the chemotherapy-inducedcardiotoxicity results from a subject receiving anthracyclines,alkylating agents, antimicrotubule agents, and antimetabolites agentsused as chemotherapy.
 39. The method of any one of claims 31-33, whereinthe cardiovascular condition is cardiotoxicity as a result of a subjectreceiving a cancer therapy.
 40. The method of claim 39, wherein thecancer therapy is a HER-2 targeted therapy.
 41. The method of claim 40,wherein the HER-2 targeted therapy comprises use of trastuzumab,ado-trastuzumab, emtansine, lapatinib, neratinib, and pertuzumab, anyanti-HER2 antibody, any anti-HER2 agent or a combination thereof. 42.The method of any one of claims 34-36, wherein the CNS-related diseaseor condition is Amyotrophic Lateral Sclerosis (ALS), Parkinson'sdisease, Alzheimer's Disease, Bell's Palsy, epilepsy and seizures,Guillain-Barre Syndrome, stroke, traumatic brain injury, multiplesclerosis or a combination.
 43. Use of the recombinant fusion protein ofany one of claims 1-26 or the pharmaceutical composition of claim 30,for treating a cardiovascular disease or condition in a subject in needthereof, the use comprising administering a therapeutically effectiveamount of the recombinant fusion protein of or the pharmaceuticalcomposition to the subject.
 44. Use of the recombinant fusion protein ofany one of claims 1-26 or the pharmaceutical composition of claim 30,for preventing, suppressing, inhibiting or delaying the onset of acardiovascular disease or condition in a subject, the use comprisingadministering an effective amount of the recombinant fusion protein ofor the pharmaceutical composition to the subject.
 45. Use of therecombinant fusion protein of any one of claims 1-26 or thepharmaceutical composition of claim 30, for treating a CNS-relateddisease or condition in a subject in need thereof, the use comprisingadministering a therapeutically effective amount of the recombinantfusion protein of or the pharmaceutical composition to the subject. 46.Use of the recombinant fusion protein of any one of claims 1-26 or thepharmaceutical composition of claim 30, for preventing, suppressing,inhibiting or delaying the onset of a CNS-related disease or conditionin a subject, the use comprising administering an effective amount ofthe recombinant fusion protein of or the pharmaceutical composition tothe subject.
 47. The use of claim 43 or 44, wherein the cardiovasculardisease or condition is Chronic heart failure/Congestive heart failure(CHF), Acute heart failure/Myocardial infarction (MI), Left ventricularsystolic dysfunction, Reperfusion injury associated with MI,Chemotherapy-induced cardiotoxicity (adult or pediatric),Radiation-induced cardiotoxicity, Adjunct to surgical intervention inpediatric congenital heart disease.
 48. The use of claim 47, wherein thechemotherapy-induced cardiotoxicity results from a subject receivinganthracyclines, alkylating agents, antimicrotubule agents, andantimetabolites agents used as chemotherapy.
 49. The use of claim 43 or44, wherein the cardiovascular condition is cardiotoxicity as a resultof a subject receiving a cancer therapy.
 50. The use of claim 49,wherein the cancer therapy is a HER-2 targeted therapy.
 51. The use ofclaim 50, wherein the HER-2 targeted therapy comprises use oftrastuzumab, ado-trastuzumab, emtansine, lapatinib, neratinib, andpertuzumab, any anti-HER2 antibody, any anti-HER2 agent or a combinationthereof.
 52. The use of claim 45 or 46, wherein the CNS-related diseaseor condition is Amyotrophic Lateral Sclerosis (ALS), Parkinson'sdisease, Alzheimer's Disease, Bell's Palsy, epilepsy and seizures,Guillain-Barre Syndrome, stroke, multiple sclerosis or a combination.53. A kit, comprising an effective amount of the recombinant protein ofany one of claims 1-26 or the pharmaceutical composition of claim 30.